Please visit www.jewishwomenshealth.org for a wide range of articles and case studies on the topic of women's health and Jewish Law. This website is designed to assist medical practitioners in providing optimal care to their observant Jewish patients.

Psychological Issues in Halachic Observance

By Chana Simmonds, LCSW

In the course of observing the laws of niddah a woman often needs to ask questions of a rabbi. If the question involves medical or psychological issues, the rabbi may consult with a physician or psychotherapist before rendering a ruling. There are times, however, when psychological problems in the observance of taharat hamishpacha require direct professional therapeutic intervention and treatment.

Obsessive Compulsive Disorder
Phobias
Marital Conflicts

Obsessive Compulsive Disorder (OCD)

OCD is characterized by repetitive and compulsive thoughts and actions: for instance, a woman may be so afraid of not observing taharat hamishpacha correctly that she feels compelled to repeat behaviors in an attempt to self-soothe or to ease the distress of unrelenting doubt.  Symptoms of OCD can begin with the first practice of these laws or at any time during the marriage.

Examples of symptoms a woman may display include:

  • Persistent anxiety as to whether she performed her bedikot (internal examinations) properly.
  • Excessive, recurrent examination of bedikah cloths without being able to decide if a stain is present or not.
  • Exaggerated mikvah preparations, sometimes taking hours.
  • Unwillingness to accept the mikveh attendant’s assurances that the immersion was complete and valid.

Chronic OCD symptoms may remain limited in scope, or become progressively more severe and disrupt a woman's everyday functioning as well as her marital life. Symptoms can also manifest themselves acutely in response to stress or trauma. A team composed of a psychotherapist, a rabbi and at times a physician is needed to deal with OCD. The psychotherapist will do a bio-psychosocial assessment to determine the modalities of treatment needed. Most often Cognitive Behavioral Therapy (CBT) is used in conjunction with sensory focus interventions, psychodynamic and/or marital therapy, hypnosis, guided visualization, and medication if indicated. Rabbinic consultation is needed when behavior modifications affecting areas of religious observance are indicated. As the health professional may not know on his own what these areas are, ongoing communication with the rabbi is a desideratum.

Phobias

A phobia is an irrational fear of an object or situation that most people consider ordinary and non-threatening. A person suffering with a phobia may acknowledge that her fears are uncalled for but still experience anxiety symptoms.  When faced with the feared situation or object, anxiety symptoms include hyperventilation, quickened heart beat, difficulty breathing, sweating, dizziness, etc. Avoidance is the defense mechanism most commonly employed, but this is not always possible. Some common phobias are:

1. Fear of water: A woman may be obsessed with the fear that she will drown or otherwise be harmed by immersing in the mikveh. Rabbinic consultation can suggest modifications to the procedure that may enable her to immerse with diminished anxiety. For example, another woman might accompany her into the mikveh. When this does not suffice, however, psychotherapy may be indicated. Treatment for phobia includes CBT (to teach relaxation and address underlying beliefs) in conjunction with a desensitization protocol, psychodynamic and/or couples therapy, hypnosis, guided visualization, and medication when indicated.

2. Fear of germs in the mikveh water: See Mikveh Immersion in the Immunocompromised Host for extra steps that can be taken to sanitize the mikvah water. These may be enough to reassure a woman that she will not become ill due to contamination. However, psychotherapy may be needed to address the underlying psychodynamics and issues if anxiety persists and disrupts a woman's ability to practice these mitzvot with a sense of deepening her spiritual practice and marital relationship.

3. Fear of doing bedikot (internal examinations): At times, rabbinically-sanctioned modifications in how bedikot are done and a reduction in their number (from a norm of twice daily during the seven clean days) may allay anxiety in this regard. When such modifications do not suffice, a psychotherapy consultation may be indicated. A myriad of dynamics may underlie such fears, such as shame about touching one's body, vaginismus, having suffered sexual abuse as a child, etc. At times CBT (teaching relaxation and talking about beliefs), combined with desensitization protocols and sensory focus exercises, will help a woman better tolerate doing bedikot. It is important to deal with feelings and fantasies which accompany and emerge from these exercises. At times a referral to a physical therapist who specializes in women's health issues is also needed. Asking questions regarding the marital and sexual relationship often reveals difficulty in these areas, as well, and a referral to a sex therapist may be in order.

Marital dysfunction

Some of the popular literature on Taharat Hamishpachah and Mikveh promise that observance of these laws will result in a happy or happier marriage. Husbands and wives who do not find this to be the case may feel confused, guilty or angry with themselves or with each other, disillusioned, or despairing of hope. By the time a rabbi, psychotherapist, or physician learns about the marital dysfunction, it may have become chronic and harmful behavior patterns may have become entrenched.

Following are some examples of conflicts.

1. A wife is angry with her husband. She feels he does not give her loving attention. They make love infrequently, often at her initiation. She complains that even on mikveh night he comes home late from work, eats, and goes to sleep, and they only make love days later at her initiative. She threatens to not go to the mikveh until he changes.

2. A wife relates that she and her husband fight constantly. He feels he is the man of the house and so he makes all the decisions, without giving consideration to her feelings. She is resentful that he does not value their time alone and has given up talking about her feelings. As the children enter college, she needs to work to help meet expenses. The marital arrangement of tolerating loneliness in silence deteriorates into constant fighting. She now refuses any sexual contact and stops going to the mikveh.

3. A husband begins first to ask for and then to demand sex during the time when his wife is counting seven clean days. He reports that he never wanted to observe the laws of niddah and mikveh, but gave in to his wife's wishes. He maintains that now it is his turn to have what he wants and if she loves him she will understand and comply. He refuses to discuss this with a rabbi and tells his wife that he will be very angry if she shares this information about their private life with a rabbi.

4. A nonobservant couple has been married for some years. The husband decides to become observant despite his wife's objections. Their rabbi suggests that this spouse approach observance gradually so as to not jeopardize the marriage. The newly observant spouse, however, chooses not to follow this guidance.

In discussing marital conflict and religious observance, it is important to remember that religion does not create the disorder; it is rather the context in which the symptoms unfold. Marital conflict has a myriad of underlying dynamics. Primary among these are:

1. Lack of shared values regarding the importance of Taharat Hamishpachah and Mikveh as the context in which marital intimacy (emotional and sexual) is developed.

2. Emotional immaturity - lack of understanding that husband and wife are different people and that each must have the capacity to hear the other's difference without becoming defensive. In addition, a mature person has developed a repertoire of relationship skills including empathy, the ability to identify and talk about feelings and thoughts, the ability to take responsibility for his or her own feelings, and good problem solving skills.

3. Failure to understand the spouse's needs and feelings. A husband may not understand his wife's feelings and needs (especially her need to be loved and appreciated) when she is menstruating, when she is going to the mikveh, or during the time that follows when physical affection and sexual intimacy are permissible. A wife may not understand her husband's feelings and needs during these same time periods.

4. Emotional difficulties and psychiatric disorders that are not identified and treated.

5. Midlife crisis - during midlife there are physiological changes that impact on a spouse's feelings about himself/herself and on the marriage. The symptoms of menopause are common knowledge in our culture, and the emotional impact on the relationship needs to be addressed. The symptoms of "male menopause" are not common knowledge. As men come into midlife they can experience changes in sexual functioning including erectile difficulties and anxieties about aging. The way these changes are or are not addressed will affect the quality of marital satisfaction.

6. Bleeding difficulties that are difficult to resolve, resulting in extended periods of physical abstinence. Individual and couples psychotherapy in conjunction with rabbinic consultation and medical intervention, when indicated, are needed to treat marital difficulties.

Chana Simmonds, LCSW is a graduate of the Wurzweiler School of Social Work and the Postgraduate Center for Mental Health. Her additional postgraduate training is in sex therapy and mindbody focused therapies. Chana is a Psychotherapist, group and workshop leader.She maintains a private practice in Teaneck, New Jersey. She can be reached at: phone 201 836 1776 and email: koltuv18@yahoo.com.


Users of Internet filtering services: This site discusses sensitive subjects that some services filter without visual indication. A page that appears 100% complete might actually be missing critical Jewish-law or medical information. To ensure that you view the pages accurately, ask the filtering service to whitelist all pages under jewishwomenshealth.org.


This material is intended for general information purposes only. The patient's individual circumstances should be considered when making specific treatment decisions.

Reproduction of the contents of this article for other than personal use
is prohibited by both Jewish and secular law.


Copyright © 2012 Deena Zimmerman. All rights reserved.