Religious Compulsions and Fears
By Avigdor Bonchek
Feldheim Publishers
Jerusalem, 2009
198 pages
Reviewed by Rivkah Rabinowitz
It is often difficult to distinguish between “normal” meticulousness and behavior that is indicative of a problem. This is especially true among Orthodox Jews whose daily lives are regimented by the minutiae of halachah. In the Orthodox community, compulsive behavior may manifest in the guise of “ultra-frum” behavior.
Determining whether one’s behavior is problematic is a challenge for both those who suffer from Obsessive Compulsive Disorder (OCD) and those around them. It is to both the sufferer and his family and friends that Dr. Avigdor Bonchek, a well-known clinical psychologist and a recognized talmid chacham, addresses his new book, Religious Compulsions and Fears—A Guide to Treatment.
Dr. Bonchek introduces the lay reader to OCD and explains the two components of this devastating disorder: obsessive thinking and compulsive behaviors, with the former triggering the latter. Dr. Bonchek discusses different therapeutic techniques helpful in treating the two components.
While self-help is definitely not the treatment course of choice when dealing with OCD, it is possible for a person with limited background in psychological disorders to use this book as a guide to recognizing problems and seeking appropriate professional help.
Throughout the book, Dr. Bonchek offers helpful insights from halachic and hashkafic perspectives. However, what makes this book unique is its focus on the religious manifestations of the disorder. Dr. Bonchek gives a clear description of how to distinguish between mitzvah performance and mitzvah distortion:
When OCD becomes related to the performance of mitzvos, the mitzvos take on a weighty burden of anxiety, which not only inflicts much psychological pain on the individual, it also causes him/her to distort the performance of the mitzvah (p. 25).
OCD manifests differently in people. Dr. Bonchek states that many sufferers are compulsive about cleanliness—they may engage in excessive hand washing or exhibit extreme germ-consciousness, for example.
Hand washing is also a vital part of religious life. For a sufferer of OCD, however, hand washing, which can be completed by most people within a few seconds, becomes a prolonged ritual, accompanied by anxiety and fear of transgression. Imagined acts, visions and smells may accompany the routine, along with repetitive checking. Repetition until it’s done “right” can be both physically and mentally painful, as well as time-consuming. And the overlay of fear of transgression makes it impossible for the sufferer to stop these acts.
A sufferer may also be overly concerned about not violating the halachot of kashrut. He may, for example, experience intense fear about having touched a dairy utensil while eating meat.
Discerning the difference between compulsive behavior and piety is possible, according to Dr. Bonchek. To the OCD sufferer, religious observance, instead of adding to the joy and sense of wellbeing of the person, injects pain and suffering.
Recovery is a process requiring hard work. True recovery, Dr. Bonchek asserts, enables an individual to live a life free of anxiety and to truly feel “ess iz gut tzu zein a yid,” “it’s good to be a Jew” and “diracheha darchei noam,” “the ways of Hashem are sweet.”
A large part of the book is dedicated to a discussion of available treatments for OCD. Dr. Bonchek’s method of choice is Cognitive Behavior Therapy (CBT), where the patient learns to recognize negative thoughts which trigger problematic behaviors, and works on changing his thinking. CBT requires significant ongoing motivation and work on the patient’s part, much of which takes place outside of the professional’s office. It is for this reason that Dr. Bonchek encourages the use of a partner or a “buddy” to accompany the sufferer throughout the healing process. As the Sages teach: “A prisoner cannot free himself from his own prison.”
The book includes a brief discussion of the medications available for OCD and their possible effectiveness. At times, the combination of drugs and a highly trained CBT therapist is most conducive to healing. Other times, particularly with a highly motivated individual, CBT alone can suffice. Each individual case needs to be evaluated by a professional.
The section on CBT, which is clear and concise, can be helpful to any friend or family member of an OCD sufferer.
While Dr. Bonchek’s book is quite informative, some questions I had while reading it were left unanswered. For example: Is there a way for parents and teachers to recognize behavior patterns that could indicate a predisposition to OCD? Does OCD manifest the same for all ages? Is there an age limit when children are expected to outgrow certain behaviors? Are there times when it is counterproductive to draw attention to OCD thought patterns and behaviors? Can behavior patterns that are ingrained over many years be changed? Is it worth the effort? Perhaps Dr. Bonchek will address these questions in a sequel to Religious Compulsions and Fears.
Overall, this book is a valuable contribution to the Jewish library, and Dr. Bonchek’s advice and analysis are useful to all.
Rivkah Rabinowitz is a family therapist practicing in Jerusalem. She also is a popular speaker and teacher.