A Guide To Treatment
By: Avigdor Bonchek, PhD
Reviewed by: FERN SIDMAN
Is there a fine line of separation between scrupulous adherence to halachic law; translating into meticulous observance of religious commandments and that of finding oneself tethered to obsessions, compulsions and fears regarding the proper method in which to perform them? Avigdor Bonchek, PhD, an ordained Orthodox rabbi who holds a doctorate in clinical psychology from New York University, tackles this question and much more, as he shares his vast knowledge regarding treatment options for those suffering from Obsessive Compulsive Disorder in his recently published book, “Religious Compulsions and Fears – A Guide to Treatment” (Feldheim Publishers).
Clearly, OCD is a universal anxiety disorder that does not differentiate or distinguish between peoples or nationalities, yet the far reaching and complex repercussions of its devastating symptoms have, over the last several decades, been acutely felt in the spheres of the Orthodox Jewish world. The foreward to this book includes the wisdom of renowned psychiatrist, Rabbi Avraham J. Twerski, MD who states, “The hallmark of a religious Jew is his dedication to fulfilling his religious duties. However, when a person becomes overly obsessed, to the point that he becomes neurotic, and is unable to function properly, it may be a sign of OCD.”
Armed with over 40 years of experience in treating those afflicted with OCD and attendant phobias, Dr. Bonchek’s inherent compassion leaps forth from the pages of this book as he assures the reader that there is indeed a light at the end of the tunnel as evidenced in a litany of pragmatic modalities of treatment What is most heartwarming is the fact that the pages of this erudite guide are permeated with the genuine care, concern, devotion and esteem that Dr. Bonchek holds for his patients, as he offers an earnest yet sensitive discussion of religious obsessions, compulsions, fears and phobias. Most common among these are obsessions pertaining to personal hygiene and cleanliness and how they impact on the performance of religious rituals. The case studies presented here include a young man who spends an inordinate amount of time in the bathroom after relieving himself, never quite feeling that he is clean enough to daven, an incessant hand washer who is obsessed with the proper observance of kashrus in the kitchen, as well as women of child bearing age who are beyond exceptionally meticulous in their preparations for the mikveh.
Other religious obsessions and compulsions include a woman who endlessly checks for bugs in vegetables, a man who spends many hours per day engaged in davening, as he never feels quite satisfied that he prays with the proper level of kavanah (dedication) so he resorts to repeating words and the entire tefilla, ad infinitum.and one who keeps repeating words of Torah during his regular learning sessions. Fears and phobias include children’s fear of Purim masks, fear of reciting brochos and tefillos in shul, and an exaggerated fear of a spouse’s infidelity. Because OCD is called “the doubting disease”, the tragic ramifications of this disorder also include constant questioning of one’s own faith. Says the author, “The individual is plagued by thoughts that undermine his beliefs; How do I know that G-d exists? How do I know that Judaism is the right faith? How do I know that the Torah and the Oral Law are valid?” He responds by telling us, “When a person performs a mitzvah and it causes him stress and anxiety, it indicates that it is not G-d’s mitzvah that he is performing, but rather some foreign behavior masquerading as a mitzvah. Among those who cannot perform a mitzvah without enduring much psychological pain is the OCD sufferer.”
Addressing the nuances of varied therapeutic approaches of treatment, Dr. Bonchek dismisses Freudian psychoanalysis or dynamic therapy as essentially ineffective, but rather embraces the more expedient Cognitive Behavior Therapy and familiarizes us with its theory and practical application. We sit in on CBT therapy sessions with Dr. Bonchek as he employs such methods as Exposure/Response prevention technique (ERP), Response Repitition, Guided Imagery (GI), Emotional Habituation, and Exposure and Closure. Because treatment of OCD can be a protracted process, Dr. Bonchek suggests that in addition to procuring a qualified therapist, a patient is advised to find a “buddy” who can assist him or her during the sometimes agonizing ordeal of working on daily compulsions that are indeed paralyzing. Sympathetically acknowledging the fear, shame and humiliation that the OCD sufferer feels, the author reveals that with much motivation, faith and hard work, the trajectory towards complete recovery and a return to a normative life is not beyond the reach for those who relinquished hope of ever extricating themselves from their personal darkness and despair.
Essential to treatment, the author tells us, is the paramount relationship between the patient and a rabbinical authority. “The rabbi must not only be a competent posek, he must also be aware of the psychological problem of OCD and how it manifests itself in the area of religious practice.” For many OCD sufferers, a clear psak from a respected rav on matters of halacha is not always a sufficient deterrent for their overwhelming compulsions because of their obsession with perfection in the performance of a mitzvah and their nagging doubts that they’ve correctly fulfilled their obligations. Yet and still, having a rabbinic advisor and familial support are essential components for successful treatment. As Dr. Bonchek advises patients in terms of fulfilling halacha as it should be, “It is not a matter of doing what “I” think is right; it is a matter of following the words of the Torah poskim.”
In terms of mitzvah observance for the OCD sufferer, Dr. Bonchek feels that “less is more” and as such brings down poignant stories from the Torah, Talmud and Kabbalistic sources illustrating the strength of character it takes for one to adopt a more flexible view of mitzvah observance; rather than clinging to their own stubborn insistence of what is proper. Of the Torah the author quotes the posuk, “It’s ways are ways of pleasantness, and its paths are paths of peace. What does Hashem, your G-d, ask of you? So that it shall be good for you. That is the bottom line – “so that it shall be good for you.” This book is a must read for any OCD sufferer, family member, friend, teacher and rabbi as we absorb profound lessons of mitzvah observance and love of Torah.