Religious Differences in Physical and Mental Health among Israeli Jews: Findings from the Global Flourishing Study.

Numerous studies have identified religious correlates of health indicators, but relatively few have been conducted among Jewish populations in Israel or the diaspora. This study investigates the possibility of a religious gradient in physical and mental health and well-being across the familiar categories of Jewish religious identity and observance in Israel: hiloni (secular), masorti lo dati (traditional, non-religious), masorti (traditional), dati (religious or Orthodox), and charedi (ultra-Orthodox). Data are from Jewish respondents aged 18 and over (N = 2916) from the Israeli sample of the new, 22-nation Global Flourishing Study, which used stratified, probability-based sampling and assessed demographic, socioeconomic, political, religious, health-related, and other variables. This analysis investigated religious differences in nine indicators of physical and mental health and well-being among Israeli Jews. Using a strategy of one-way ANOVA and ANCOVA, adjusting for complex sampling design components, a statistically significant "dose-response"-like gradient was found for eight of the outcome measures, validated by additional multiple comparison tests. For four "positively" worded indicators (physical and mental health, happiness, and life satisfaction), scores increased consistently from the hiloni to the charedi categories. For four of five "negatively" worded indicators (bodily pain, depression, anxiety, and suffering), scores decreased across the same categories. Results withstood adjusting for effects of age, sex, education, marital status, urbanicity, income, and nativity (whether born in Israel). Among Israeli Jews, greater religiousness was associated with higher levels of health and well-being and lower levels of somatic and psychological distress.

The Scientist, the Therapist, and the Conspiracy Theorist: Three Responses to the COVID-19 Pandemic Within the Ultra-orthodox Jewish Revival Movement in Israel.

This article examines the responses of three rabbis to the Coronavirus (COVID-19) pandemic in Israel and the distinctive approach and strategy expressed by each of them: (1) rational-scientific, (2) emotional support, (3) resistance and distrust. The first two rabbis maintain that they trust the medical institutions and the government, whereas the third rabbi evinces distrust, expressed through conspiracy theories. These different approaches can be explained by their dispositions prior to the pandemic, which were exacerbated by the Coronavirus. Hence, COVID-19 served as more of a reflecting phenomenon than an agent of change. Analyzing the dispositions of the three rabbis can show us how they are related to two significant forces of the twentieth and twenty-first centuries-science (rational-scientific and resistance and distrust) and psychology (emotional support). Psychological discourse has been used to promote public health. On the other hand, the scientific discourse has been used to promote adherence to government and health ministry directives, as well as to oppose those directives.

Women Who Perform Social Egg Freezing as Moral Pioneers: The Case of Ultra-Orthodox Communities in Israel.

Social egg freezing (SEF) is a new reproductive technology that is increasingly used within ultra-Orthodox Jewish communities, stirring tensions between tradition and modernity. Based on in-depth semi-structured interviews, this study examined how ultra-Orthodox singles who employ SEF engage in social negotiations over gender- and body-related norms. Findings show that participants successfully assimilated SEF by establishing facts on the ground and discreetly spreading information while actively avoiding tensions that may threaten religious tradition. SEF did not push participants into modern individualism or dissolve their strong connection to the community. However they did modify social boundaries and articulated social criticism.

Cesarean Sections and Family Planning Among Ultra-Orthodox Israeli Jews.

The elevated frequency of Cesarean sections (C-sections) in OECD countries not only burdens health systems financially but also heightens the risks for mothers and infants. This study explores the feasibility of reducing C-section rates by examining the Israeli ultra-Orthodox population, noted for its large families and low C-section rates. We analyze birth data from an Israeli hospital, focusing on ultra-Orthodox mothers with husbands who are yeshiva students compared to other mothers. Our findings reveal that all else being equal, mothers married to yeshiva students exhibit a lower likelihood of undergoing a C-section and a higher propensity to seek private medical services to avoid this procedure. This behavior is attributed to their preference for large families and the desire to minimize C-sections, which may restrict the number of possible future pregnancies. These insights underscore the potential effectiveness of initiatives encouraging mothers to opt for vaginal deliveries, thereby reducing healthcare costs and maternal-infant risks.

A Permissible Sin: Perceptions of Smoking Among Haredi Men in Israel.

This essay deals with perceptions of smoking among Haredi men in Israel. Though trends in smoking within the Haredi society have been quantitively examined, no qualitative research has ever focused on the motivations and mindsets stimulating individuals' choices to take health risks despite religious precepts to the contrary. Israeli Haredi men sometimes start smoking in their early childhood and are unmotivated to quit, and such circumstances should be examined. We interviewed 20 Israeli Haredi male smokers and overviewed the Haredi daily press and rabbinical attitudes toward smoking. Our findings indicate that Haredi men typically consider smoking as either permissible or, at worst, a minor sin. From childhood they view smoking as an expression of maturity, and moreover one which is associated with Jewish holidays and particular religious practices. Such perception relies on the Haredi establishment's normative exclusion of smoking from the Halachic commandments that aim to protect health. Finally, we illustrate key points to consider in paths leading to an intervention process to change these norms and practices.

"I Would Consult a Doctor, But What the Rabbi Says Goes": Ultra-Orthodox Jews' Relationships with Rabbis and Doctors in Israel.

We examine relationships among ultra-Orthodox Israeli Jews, their doctors, and rabbis when medical decisions are made. Analyzing excerpts from sixteen focus groups with 128 ultra-Orthodox Jews, we determine how their belief system affects their decisions about whom to trust and follow when the doctor's instructions contradict the rabbi's advice. We argue that the strict behaviors described here with regard to relations among doctors, rabbis, and patients, function as social capital that raises the status of ultra-Orthodox Jews as members of an exclusive club that balances health decisions with the social demand to obey their religious leaders.

"Sense for Gambling" Among Jewish Ultra-Orthodox Men With Gambling Disorder.

Making sense of the social world is an intricate process heavily influenced by cultural elements. Gambling is a prevalent leisure-time activity characterized by risk-taking conduct. While some individuals who engage in it do so without experiencing any harm, others will develop gambling problems. Judaism tends to perceive gambling negatively since it contradicts fundamental Jewish principles. The current study focuses on the Jewish Ultra-Orthodox community in Israel which is characterized as a cultural enclave with minimal interaction with the secular world. Hence, it provides a unique and novel socio-cultural context to inquire how individuals with gambling disorder (GD) from this community make sense of gambling. Following constructivist grounded theory guidelines, 22 Ultra-Orthodox men with GD were interviewed using a purposeful sampling design. Sixteen Rabbis were also interviewed, illuminating the socio-cultural context of Halachic regulations and norms regarding gambling in this community. An abductive analysis of the data, interwoven with Bourdieu's concept of habitus, yielded an overarching theme that we dub as "sense for gambling," encompassing matrices of Ultra-Orthodox external (e.g., a conservative cultural structure with numerous prohibitions and life marked by poverty) and internal (e.g., feelings of loneliness, dissatisfaction, and deviance) dispositions imprinted onto the body, creating diverse embodied reactions (emotional and sensory) to gambling, and leading to developing GD. We recommend placing the body, as the locus of internalized dispositions, at the core of examination when researching pathways to GD. We propose that this intricate interplay between external and internal dispositions shapes the decision-making regarding gambling, thus mitigating individual responsibility for GD.

Awareness, Incidence and Psychological Wellbeing of Childhood Sexual Abuse as Reported by Ultra-Orthodox Mothers.

The harm caused by child sexual abuse (CSA) is well-documented, calling for more awareness and efforts at prevention. However, CSA in closed religious societies is still tightly under wraps, and therefore underreported and understudied. We chose to use the mother's point of view, in order get an estimate of the prevalence, the reporting rates and their psychological wellbeing. The current study aims at addressing this in the Jewish ultra-Orthodox community, an insular religious one, which may thus serve as a test case for understanding other closed, religious communities. Three hundred forty-seven ultra-Orthodox Israeli women completed self-report questionnaires and reported on their, or their children's exposure to CSA sexual abuse, about their emotional coping, and about considerations regarding disclosing the abuse. About 24% the participants reported that they were victims of sexual abuse. Only 24.3% of cases were reported to the police or official welfare services, with cultural reasons offered by the women to explain it. Lower psychological wellbeing was found among mothers who themselves or their children were victims of child sexual abuse, compared to controls. Interestingly, mothers who reported having undergone psychological treatment suffered a higher degree of distress than those who had not. These findings contribute to the understanding of the dynamics of sexual abuse exposure and disclosure in the ultraorthodox community, and in close societies and highlight the changes required to improve safeguarding of children.

Support and Informational Needs of Ultra-Orthodox Jewish Women Coping with Advanced Cancer: A Pilot Observational Study.

In Israel, as in other countries, the emotional and physical needs of minority populations receiving palliative care, are largely unknown. The ultra-Orthodox Jewish sector is one such minority population. This study's goal was to identify perceived social support, desire to receive information about illness and prognosis, and willingness to disclose information to others. Various measures assessing perception of social support, psychological symptoms and information disclosure were completed. Fifty-one women consented to participate; approximately 50% of participants had disclosed the diagnosis to their rabbi or a friend, in addition to their spouse. Almost all of the participants would want to be told if their condition were worsening (86.3%), yet only 17.6% reported that their doctor had discussed future care options if their health situation were to worsen. Overall, participants felt that the level of support they received was high and reported low levels of mental distress. This is the first known study regarding perceptions and needs of ultra-Orthodox Jewish women with advanced-stage cancer. Both diagnosis disclosure and palliative care options should be addressed and discussed with these patients so they may make important end-of-life decisions.

Ultra-Orthodox Women in the Job Market: What Helps Them to Become Healthy and Satisfied?

This study explored the mental health and job satisfaction of Ultra-Orthodox women who work in different cultural environments. Data were gathered from 304 Ultra-Orthodox women who belong to various streams in this society and who were recruited by the Midgam research panel. The participants filled out self-reported questionnaires that assessed their family quality of life, community sense of coherence, diversity climate, inclusive leadership, job satisfaction, and mental health. The participants ranged in age between 19 and 64 years (M = 30.86, SD = 8.71); 43.1% worked within the Ultra-Orthodox enclave, while 22.4% worked with both Ultra-Orthodox and secular individuals and 34.5% worked in mainly secular environments. We observed differences and similarities among the three groups of women. Community sense of coherence was weakest among those who worked outside the enclave, while diversity perception and inclusive leadership were highest among that group. In all three groups, family and community were the most important resources for mental health. Both traditional resources (i.e., family and community) and other resources (i.e., perception of diversity climate and inclusive leadership) were important for job satisfaction.

"I don't fit into any category": Adult perspectives on the dynamics of past sexual acts between siblings in Jewish Orthodox society.

BACKGROUND: 'Harmful sexual sibling behavior' is a term used in this study to refer to childhood sexual behaviors, including abuse (SSA), that are inconsistent with the category of age-appropriate curiosity. Although SSA may be the most prevalent and longest-lasting form of intrafamilial sexual abuse, it is the least reported, studied, and treated. OBJECTIVE: This study aims to deepen our understanding of the sexual characteristics and dynamics of such behavior, as perceived by those involved. PARTICIPANTS AND SETTING: Twenty adults from the Orthodox community in Israel, who experienced sexual interactions with one or more of their siblings, were recruited as participants. METHODS: This qualitative, constructivist, grounded-theory study was based on semi-structured interviews with 20 adults. RESULTS: Four types of sexual dynamics were revealed: an "abusive dynamic," "mutual relations," "sexual routine," and "incidental," with the latter stemming from a new understanding that deepens our knowledge of the subject. The participants discussed the broad, long-term consequences and life-long psychological implications of each dynamic and the coexistence of these dynamics. The results also reveal two cultural dimensions of the participants' perception of the sexual acts: "lack of sexual knowledge" and "the perception that all religious prohibitions are of equal severity." CONCLUSIONS: The findings highlight the importance of adapting interventions to the siblings' perceptions and avoiding treatment that exacerbates their complex situation. We employ the concepts of dynamics and dimension in describing the phenomenon rather than continuum. The study also highlights the importance of understanding relevant religious-cultural factors.

The Urologist's Guide to Religion and Male Factor Fertility Treatment.

OBJECTIVES: To create a reference guide for six of the major U.S. religions for use by reproductive health specialists to provide patient-centered care for a culturally diverse patient population. MATERIALS AND METHODS: We utilized primary source reviews of various religious texts and verified electronic databases to examine perspectives on use of, in vitro fertilization (IVF), intrauterine insemination (IUI), sterilization procedures such as vasectomy and tubal ligation, and surrogacy for six major U.S. religions: Catholicism, The Church of Jesus Christ of Latter-Day Saints (LDS), Hinduism, Judaism, Buddhism, and Islam. Each statement of religious belief was either taken directly from primary source documents or cross-referenced across several secondary sources to ensure accuracy. Perspectives were compiled into a reference document and table for clinical use. RESULTS: Most religions have focused statements concerning assisted reproduction and vasectomy. While there are caveats for most religions, IVF and IUI are largely opposed only by the Catholic church, surrogacy is not permissible in the LDS Church, Catholic Church, and Islam, and vasectomy is not permissible for the Catholic Church, LDS Church, Judaism, and Islam. Similarly, tubal ligation is also not permitted for these religions with the exception of Judaism of which while vasectomy is considered a violation of the Torah, sterilization of a woman is not explicitly discussed in the old testament. Instead, a rabbinic decree states permanent female sterilization as against the views of the faith. The religions with the most lenient rules concerning reproduction and permanent contraception explored include Buddhism and Hinduism each of which have no reservations pertaining to IVF, IUI, surrogacy, or permanent sterilization. CONCLUSION: Religion often plays a significant role in patients' attitudes towards use of ART, permanent sterilization, and surrogacy. Familiarity with the religious beliefs and perspectives is important for the reproductive health specialist in order to provide appropriate counseling for their patients. IMPACT STATEMENT: A summative reference guide can help provide patient-centered care for reproductive health and family planning.

A comparative study of mental health diagnoses, symptoms, treatment, and medication use among Orthodox Jews.

Historical clinical reports and media narratives suggest that Orthodox Jews are reticent to seek treatment for mental illness, present only with serious concerns, and hesitate to comply with treatment in general and psychopharmacology in particular. On the other hand, recent developments, and some limited research, suggest that Orthodox Jews may be likely to seek and comply with treatment. The current study compared the diagnostic, symptomatic, and treatment characteristics of 191 Orthodox Jews and 154 control patients all presenting to a large private mental health clinic with offices throughout greater New York. Results indicated that the groups were largely demographically similar, and that their diagnoses did not significantly differ. Orthodox Jews initially presented with lower levels of symptoms, terminated with similar symptom levels, attended a similar number of sessions, and were equally likely to use psychopharmacological interventions of similar types, compared to controls. This was equally true of ultra-Orthodox and modern Orthodox Jews. Clinicians providing mental health services to Orthodox Jews should be aware of these findings, which contrast with existing clinical and popular stereotypes. Further, excessive efforts to protect Orthodox Jewish patients against stigma may be unnecessary and counterproductive.

Child Sexual Abuse by Religious Authority Figures in Germany and Israel: The Experiences and Perceptions of Adult Survivors.

The current study is based on an in-depth thematic analysis of 20 interviews with German and Israeli adult survivors of child sexual abuse (CSA) by religious authority figures (RAF). This paper aims to explore survivors' experiences within the Jewish ultra-Orthodox and Christian communities, as well as to draw comparisons between the abusive structures and disclosure in these two contexts. The results point to the complexity of CSA by RAF, which is embedded in the survivors' perceptions of themselves as emotionally and cognitively captured by the perpetrators who are a symbol of a parent or God and faith. The participants expressed great concern regarding disclosing the abuse against the backdrop of familial, cultural, and community inhibitors, such as fear of social stigmatization, inability to recognize the abuse, and the taboo of sexuality discourse. The survivors' traumatic experiences were intensified in light of negative social responses to disclosure and encounters with insensitive officials. A comparison of the cultures revealed differences regarding the nature of community life and educational institutions, which may have shaped the disclosure and recognition of the abuse. The study highlights the importance of comparative follow-up studies related to this phenomenon in order to examine its universal and unique cultural contexts.

The Experience of Mothers from the Israeli Jewish Ultra-Orthodox Sector after Disclosure of Their Child's Sexual Abuse as Manifested in Drawings and Narratives.

Child sexual abuse is present in all strata of Israeli society. However, there is scant research on the emotional experiences of non-abusing mothers after disclosure. In particular, no studies have examined the experiences of these mothers from the Jewish Ultra-Orthodox community in Israel. The current study analyzed the drawings and short narratives of 21 Israeli Ultra-Orthodox mothers to explore the effects of the disclosure of their child's sexual abuse. A phenomenological approach was used to analyze the drawings and yielded four different phenomena: (1) squiggles that represented distress, (2) the mother-child relationship, (3) pseudo-sweet houses, and (4) split drawings. The drawings were either colorful, sweet or shallow, or alternatively were in black and white. As confirmed by the narratives, these drawings primarily expressed the negative emotions of shock, sadness, distress, guilt, and failure as mothers. While some mothers reported breaking down and that pain had permeated their daily lives others coped by dissociating the painful experience, putting up a façade of normalcy, or splitting their lives into two parts corresponding to before and after the disclosure.

How are psychotic symptoms and treatment factors affected by religion? A cross-sectional study about religious coping among ultra-Orthodox Jews.

Religious coping is prevalent among individuals diagnosed with psychotic disorders, however its clinical relevance has been insufficiently studied. Thirty ultra-Orthodox Jewish patients experiencing current psychotic symptoms and receiving treatment in the inpatient and day-care units were administered measures assessing severity of psychotic symptoms, psychological distress/well-being, beliefs about treatment credibility/expectancy, and aspects of religious belief and coping. Among men, negative religious coping was associated with lower treatment credibility. Among women, positive religious coping was associated with increased treatment expectancy and greater quality of life; and trust in God was associated with reduced psychiatric symptoms and greater treatment expectancy. Study findings indicate that religious factors may promote treatment motivation and engagement, crucial factors for subpopulations facing culturally-based barriers to treatment, as well as boost more favorable outcomes. Sensitivity to religious factors in treatment appears to play an important role in the management of psychotic disorders and should be engaged when culturally appropriate in order to maximize treatment potential.

The last Talmudic demon? The role of ritual in cultural transmission.

Recent work on the evolution of religion has approached religions as adaptive complexes of traits consisting of cognitive, neurological, affective, behavioural and developmental features that are organized into a self-regulating feedback system. Religious systems, it has been argued, derive from ancestral ritual systems and continue to be fuelled by ritual performances. One key prediction that emerges from this systemic approach is that the success of religious beliefs will be related to how well they are connected to rituals and integrated with other elements of the religious system. Here, I examine this prediction by exploring the rich world of Jewish demonology. As a case study, I briefly survey the historical trajectory of demonic beliefs across Jewish communities and focus on one demon, a ruach ra'ah, that has survived the vicissitudes of Jewish history and maintained its relevance in contemporary Jewish communities. I argue that it has done so because of its linkage with a morning handwashing ritual and its effective integration into the core elements of Jewish religious systems. This article is part of the theme issue 'Ritual renaissance: new insights into the most human of behaviours'.

Informal Milk Sharing for the Hospitalized at-Risk Infant in the Ultra-Orthodox-Haredi Jewish Community in the United States.

The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member of the team, using a semistructured interview guide. Informal milk sharing was regarded as a positive empowering experience. Themes which illuminate the phenomena of milk sharing include faith, mistrust of the medical establishment, a strong reliance on social connectedness, and importance of sacred cultural traditions. Health care providers need to be aware of these specific needs to provide culturally sensitive care for safer milk sharing practices in cloistered and faith-based communities.