Alan Slomowitz & Alison Feit. Journal of Gay & Lesbian Mental Health. Volume 19, Issue 1. 2015.
An Orthodox Jewish man walks into his Rabbi’s office and says: “Rabbi, I seem to be only attracted to other men. This is prohibited! What should I do?” The Rabbi says “What?! Do I look like a therapist? Hold on, I’ve got Dr. Goldstein on speed dial.”
While not the best of jokes, this vignette illustrates an interesting phenomenon about Orthodox Jewish life and its relationship to the mental health field. It asks its audience to ponder some serious questions: Why does the man want to talk to his rabbi about being gay? Is it a problem? Whose problem is it? His or the rabbi’s? What is it that he hopes to gain from such a conversation? What is it that the rabbi feels unequipped to say? What does he hope Dr. Goldstein will offer? And why is Goldstein on the rabbi’s speed dial? In short: What is the role of a psychotherapist when dealing with homosexuality and men and women with same-sex feelings and attractions in the Orthodox Jewish community?
Mental health resources are not uncommon in Orthodox Jewish communities. Organizations such as Ohel, Relief, and The Jewish Board of Family and Children Services are several among many that specialize in providing mental health services to the Orthodox community. Most Orthodox groups are not closed off to advances in science and healthcare. In medical, financial and political areas, Orthodox Jews are generally encouraged to engage with secular cultural expertise (Soloveitchik, 1964). This is true across the spectrum from Modern Orthodox through Ultra-Orthodox populations. Orthodox Rabbinic medical ethics are usually rooted in the most contemporary findings in science and research. Jewish law as to what is and is not permitted takes on a technical/legalistic nature and application once scientific authority and clinical best practices are established. This is true of many medical and ethical decisions such as end-of-life decisions surrounding brain death and organ donations where Orthodox Jewish law must be integrated with the latest medical knowledge (Tendler, 1990).
In contrast, controversial psychological-cultural issues within the Orthodox community having to do with mental health have become major points of disagreement and opprobrium when it comes to diagnosis and treatment. This is most notable with regard to homosexuality and the concept of sexual orientation.
The joke at the beginning of this paper points to a serious question in contemporary Orthodox Jewish society: What are the clinical and cultural meanings of a referral from a member of the clergy to a clinician? This issue is not only about treating a perceived “illness” but also potentially preventing a sin.
For sexual orientation issues, clinicians used to have a clear cut answer for Jewish Orthodoxy. Until 1973, homosexuality was considered a mental disorder (Bayer, 1987), so the rabbi (and his congregant) could both conceptualize being gay as a “disease” and the referral was simply to a doctor who could provide a “cure.” In other words, the cultures of Orthodox Judaism and official mental health practice were aligned. But for the past 40 years that has not been the case. In the differing views of the Ultra- and Modern-Orthodox communities, while over the past 10-15 years the cultural divide has both widened and narrowed, the impact of this divide is still significant.
Although Orthodox Jewish culture has continued in its opposition to open expressions of homosexuality, it has also split into two divergent paths within Orthodoxy. The Ultra-Orthodox point of view maintains that not only is homosexuality a forbidden practice, the concept of identifying as gay or homosexual is not recognized. Believing oneself to have a gay sexual orientation is regarded as a false, willful and rebellious act. As Rabbi Avraham Edelstein (2013), an Ultra-Orthodox rabbi puts it, “Judaism is opposed to defining people as gay … There is, in fact, no word in Judaism for a gay person per se … Judaism doesn’t define people based on sexual desire.” In essence, gays do not or cannot exist in Rabbi Edelstein’s brand of Judaism. There are homosexual actions that are forbidden, but the possibility or concept of a homosexual identity or orientation does not exist in the Ultra-Orthodox community.
However, there is a Modern Orthodox viewpoint, as represented by Rabbi Yuval Sherlo, which does not see things in the same way. The culture of the Modern Orthodox community has shifted in the past two decades and offers the potential for dialogue and engagement. For example, Schweidel (2006) explains that while Rabbi Sherlo believes homosexual activity is strictly forbidden and that there is no way for Orthodox Jewish law to permit such practices, Sherlo also maintains that a person who identifies as homosexual cannot and should not be excluded from the community and the synagogue. He can be a fully functioning member of the synagogue. Sherlo is one among many Modern Orthodox rabbis who recognize the existence of a gay identity and the conflict experienced by gay men and women between their sexual orientation and Jewish law.
Despite the growing internal cultural conflicts within the Orthodox Jewish community, both of these religious viewpoints conflict with current mental health understanding. Contemporary mental health professionals are trained to accept a wide variety of sexual orientations and desires. In contrast, Orthodox Jewry consults such professionals for a “solution to the homosexual problem” and continues to believe that this solution is found in the world of mental health.
The most recent iteration of this conflict surrounds sexual conversion “therapies” and whether they are valid, effective or ethical. Despite the growing body of literature that argues against any scientific validity for the efficacy of Sexual Orientation Conversion Efforts (SOCE) and the position statements of both the American Psychological Association (2009), and the American Psychiatric Association (2000), that such treatments don’t work, the rabbinic world has continued to support these types of therapies as the solution for “the gay problem” (Torah Declaration, 2011). For the Ultra Orthodox, this is consistent with their viewpoint that there is no underlying sexual orientation that needs changing. Their only measure of cure is the cessation of any homosexual acts. If there are “therapies” that can stop such activities, they are considered to be successful and ethical.
While a referral to a mental health professional may be helpful, if suggested in an empathic and nonstigmatizing fashion, the often unstated (and perhaps unconscious) wish within the Orthodox community is that whatever magic therapists pull off in helping with self-esteem, family issues, personality issues, eating disorders and drug addictions can and should be accomplished with regard to unacceptable homosexual behavior. The implicit request made of the clinician, however, is to stop the unacceptable desire itself. That is, if a patient wants it enough and a clinician is talented enough, perhaps a queer cure of biblical proportions can be performed.
Does “Fluid” Sexuality Imply an Ability to “Change” or “Choose” Sexuality?
The Orthodox point of view is an essentialist one regarding gender and sexuality. It is captured by Englander and Sagi’s (2013) recent book, New Religious-Zionist Discourse on Body and Sexuality. The majority Orthodox Jewish point of view believes in a particular God-given essentialist core identity that is either male or female. This essentialism is also exemplified by another Ultra-Orthodox rabbi, Rabbi Aharon Feldman (2012). Feldman writes about drives and bodily desires (think Freudian Id) that try and overcome the soul (think Freudian Ego). According to Feldman, it is critical that one become Other-centered and not Self-centered and the reproductive drive is the most powerful determinant of this process. Only if the reproductive drive is used to effect a sexual relationship between a man and a woman can the person become Other-centered and therefore “healthy.” Any other sexual relationship, such as between same sex couples cannot be Other-centered, is unhealthy, sinful, and therefore cannot exist or be tolerated.
The Utra-Orthodox community believes that since male and female are different biologically, they must be different cognitively and emotionally. According to this viewpoint, humans who act or feel differently from this way of being are by definition violating their “true” self and role in the world. Any attempt to legitimize a different role identity, such as a gay identity, is not only going against this essentialist philosophy but is also seen as a purposeful act of sin.
Many decades of research have made it clear that some individuals vary a great deal in the potential fluidity of their sexual attractions. There are also gender differences in such fluidity as well, as at least some women experience a greater variety in their sexual attraction to others over their lifespan than men (Diamond, 2009). Yet the implications of this research are not immediately clear. Should an Orthodox therapist focus on sexual conversion in therapy for female patients to a greater degree than when treating male patients? Are reported changes of sexual behavior or attractions of either gender merely a function of “wishful thinking” on the part of both the patient and clinician? At this moment in psychological research and practice, these questions have no clear answers. In contemporary life, this uncertainty has led to a strange fusion of mental health and religious authority structures.
There does appear to be significant confusion within the Modern Orthodox world about sexual orientation and the potential to change it. Even those who attempt to write about this topic in a factual, sensitive and caring manner express views that demonstrate a certain lack of clarity and understanding. Debow (2012), an Orthodox clinical psychologist who trained at Bar Ilan University in Israel, wrote one of the best English language books on the Orthodox approach to sexuality. Talking About Sexual Intimacy: A Guide for Orthodox Jewish Parents addresses its subject within the normative conversations that Orthodox Jewish parents have with their children. Yet when attempting to answer the question, “Can people learn not to be homosexual?,” even Debow gets caught up in the current religious climate of obfuscation around clinical efforts to change sexual orientation. At one point (p. 237) she states that conversion therapies are highly controversial in the academic field and that there are few long-term successes. A few lines later (p. 237) she notes, “on the other hand, there are a number of religious organizations (Jewish and Christian) that offer conversion therapies … who claim to have much success.” Debow does not attempt to make sense of this current state of affairs. It is easy to see how a parent who turns to this book for a definitive view about how to help their child might come away confused.
It is easy to understand why such puzzlement occurs. If some people are sexually “fluid” then why can’t they be helped to “swim” towards the heterosexual end of the swimming pool? Diamond (2009, pp. 252-253) attempts to explain how such fluidity does not imply that SOCE can actually change sexual orientation. She quotes Beckstead’s (2006, pp. 75-81) research: “ … at the end of therapy, they could still be aroused erotically by the body shape of same-sex individuals … Participants reported that therapy helped them change their thinking about and expression of homosexuality and sexuality but not their actual sexual orientation.” Diamond explains that “sexual fluidity does not imply individuals can mold either their sexuality or someone else’s into a pattern of their choosing. Variability does not equal choice … ” It is precisely this understanding of the complexity of same-sex and other-sex sexuality that is lacking in both Ultra- and Modern-Orthodox Jewish culture. It has led to the misguided push towards trying to change anyone who wishes to, despite the small odds of change for most people.
The Clinical Conundrum
To return to the question about the referral by an Orthodox rabbi of a lesbian, gay, bisexual, transgender, and queer (LGBTQ) person to a therapist, what is the implicit meaning in making such a referral? That the person is not normal? After all, heterosexual people are not referred to therapy because they are straight. Or perhaps there is something, not only about the sinful nature of homosexuality itself, but that a person might identify as “gay” that leads to a referral? Such an identity would be viewed as either defining oneself as a nonentity that cannot exist or as a member of a group to be either pitied or, at best, treated with compassion but looked upon as inferior and troubled.
In contrast, would this rabbi make a mental health referral if a straight person came to him and disclosed he was experiencing strong sexual attractions to married women—which is also a “sin?” Would a referral be made if this man came to him and said he wanted to marry a non-Jewish woman? Would he prefer this man marry a non-Jewish woman rather than a Jewish man? In any of these other cases would the rabbi speed dial Dr. Goldstein? What about other sins? Are we living in an age where therapy is seen as a first line tool in combatting the yetzer harah (literally translated as the evil inclination, the religious equivalent to the Freudian Id)? If so, where will this all lead? Rabbis suggesting mental health counseling for the Orthodox Jew who has trouble keeping kosher and is compulsively drawn to McDonald’s double cheeseburgers?
Given the above, there is concern that clinicians may not question the Rabbi’s implied assumption that an Orthodox Jew who is interested in others of the same sex has “something to work out.” Does the Orthodox clinician unconsciously buy in to the notion that on some level a gay person is unwell, both spiritually and psychologically? An individual can have psychological difficulty reconciling a gay identity within the Orthodox Jewish lifestyle and feel anxious or depressed as a result (perhaps this is best seen as some type of social trauma), but not necessarily because there is something inherently mentally disordered about that attraction. Anxiety or depression around sexual orientation can be a good reason to seek treatment but perhaps a particular person is not emotionally troubled by their sexual desires. Is it ethically possible to treat a gay man referred by an Orthodox rabbi who believes the goal of therapy is sexual behavior or orientation change? What obligations do clinicians have and how will these differences affect the way a treatment is conducted?
Bridging “Incommensurable” Differences
In an effort to grapple with these questions and find some common cultural ground, certain aspects of psychoanalytic theory and praxis may be helpful.
Edgar Levenson (1988) attempts to highlight and struggle with a parallel problem in psychoanalytic theory: two psychoanalytic perspectives that each purport to explain human motivation. He noted this problem in reference to questions where each psychoanalytic perspective establishes a different order and each ideological framework claims to explain everything. He uses the term “incommensurable” to describe worldviews that rest on fundamentally different a priori assumptions and offer two paradigmatically different views of the world. For Levenson, conflict has always been the nature of human discourse. This concept is well known to Jewish thought and learning as well as to psychoanalysis.
Levenson’s problem of “incommensurability” has been intrinsic to discussions within psychoanalysis for decades, as there are many psychoanalytic models that attempt to explain all of human experience to the exclusion of any other psychoanalytic model. Greenberg and Mitchell (1983) draw attention to this psychoanalytic problem in their side by side comparison of many psychoanalytic theories. Mitchell (1988) later wrote that “the history of psychoanalytic ideas has developed not smoothly and linearly but in jumps and lurches in a dialectical field of conceptual possibilities created by sets of polarized concepts: fantasy/reality, insight/relationship, conflict/developmental arrest, oedipal/preoedipal, and intrapsychic/interpersonal. They arise as dichotomies…” (p. 494).
For Levenson and Mitchell, conflicts are mainly expressed in theory and not always in practice. For the Orthodox Jewish clinician, the conflict about homosexuality is intensely fundamental. One side sees homosexuality as a problem in itself and the other does not. It is a dichotomy between illness and health, virtue, and sin. The binary essentialism of this Orthodox Jewish point of view may make it difficult if not impossible to acknowledge a competing theory of mind and being which might lead to a plurality of Orthodoxies (as oxymoronic as that may sound). Can radically different perspectives be viewed through the lens of complementary views of a common experience? Or are Orthodox Jewish clinicians trapped within a never-ending battle for an essential truth that will always prove to be elusive?
Nevertheless, change is occurring. The change going on within Orthodox Judaism is most likely happening out of the community’s conscious awareness. While there are innate aspects to human development, according to contemporary interpersonal and relational psychoanalytic theory, individuals cannot help but be influenced and changed by the culture around them. Even the most insular groups of Orthodox Jews are not immune to outside influence. In this context, Orthodox Jewry will need contemporary, new and different ways to formulate categories of illness and health, as well as virtue and sin. One cannot predict how Orthodox Judaism will resolve these apparently incommensurable conflicts, although the following is a potential opening through which one might begin.
One way of opening discussion is to consider the problems a person who identifies as an Orthodox Jewish gay person might face. Rather than seeing a gay orientation as an internal battle of superego versus id, contemporary psychoanalysts view individuals as composed of many shifting self-states, which leave room for the individual to have wholly elaborated emotional lives with different states of experience that might be quite disconnected from one another. As Bromberg (1998, 2001, p. 270) notes, “ … a noticeable shift has been taking place with regard to psychoanalytic understanding of the human mind … towards a view of the self as decentered, and as the mind as a configuration of shifting, nonlinear, discontinuous states of consciousness in an ongoing dialectic with the healthy illusion of unitary selfhood.”
Stern (2010, p. 139) writes that “the mind is therefore theorized not as a vertical organization of consciousness and unconsciousness, but as a horizontally organized collection of self-states, states of being, or states of mind, each in dynamic relation to the others.” Through these lenses, Orthodox Jewry could have a different perspective on understanding human experience. The Orthodox community may need to acknowledge that thoughts, feelings and behaviors that interfere with their traditional framework often occur out of awareness and cannot be looked at by the community itself. The key process active in this theory of mind is dissociation, a kind of splitting of the mind (Sullivan, 1956).
Such conceptions of the way the mind works can lead to important steps in understanding the Orthodox Jewish gay experience and the Orthodox rabbinic understanding of such experiences. For example, if such an individual is in synagogue and his emotional and spiritual core are engaged, part of him is fulfilled, yet the parts of him that are focused around gay identity are less accessible, as there is little space for such self-reflection in a religious environment. However, if the same person is at an LGBTQ event on a Friday night, part of him may be engaged and feel at home with similarly identified peers, but other parts of himself and his religious experience may not be fully available to conscious thought and experience. Similarly, Rabbi Sherlo’s attempts at engaging the Orthodox gay individual as he is and accepting his identity as well as welcoming him into the synagogue demonstrates a less binary and more nuanced grasp of what an embodied gay person experiences as opposed to a disembodied concept of how one ought to be.
Stern (2010, p. 140) notes that some self-states are bearable but uncomfortable (e.g., one is able to admit that one is envious or competitive with others). These states of mind may not be ‘fun’ but they are tolerable. Drawing upon the work of Sullivan (1953), he calls such states “bad me.” However, there are states of mind that cannot be tolerated, these are dissociated and cannot be “experienced simultaneously” and “remain sequestered from the others.” These states of mind are experienced as alien to the individual and are defined as “not-me.” It is these “not-me” parts of self, which are defended against actively and unconsciously and remain what Stern calls “unformulated.” These feelings cannot be experienced as one’s own without severe psychic consequences.
Such is the state of mind of many young Orthodox individuals at the cusp of marriage who cannot bear to formulate the hazy sexualized attraction to same sex others because the notion of ‘being homosexual’ is so horrific, so “not-me” that it cannot be tolerated. In a broader cultural framework, it is this cultural dissociation that led to an “Anti-Internet” rally attended by more than 60,000 people, that was sold out to Ultra-Orthodox communities, yet which was sponsored by an Internet company where most of the attendees used their smartphones during the event.
In terms of same-sex attraction, in Rabbis Feldman and Edelstein’s world, the gay person is a “not-me,” an intolerable impossibility. In Rabbi Sherlo’s world, a gay identity approaches a “bad-me,” a state that at least can be acknowledged and articulated. While the mental health community may not agree with such a conception, at least it becomes possible to discuss and formulate the different viewpoints across the divide.
One may now circle back to the young Orthodox man in the rabbi’s office where Dr. Goldstein is on speed dial. Through a contemporary psychoanalytic lens it would appear that both the young man and the rabbi are mutually enacting and dissociating what for them is an unbearable and intolerable experience: the possibility that there is anything normal or acceptable about the congregant’s same-sex attraction. It must therefore be conceptualized as a sign of illness, a status of “not me.” The notion that an essential queerness is not something to be cured and may be lived with is simply unbearable in this context. Because the Biblical prohibition is so direct (it is written twice, called an abomination, and in the second reference a heavenly death penalty is decreed) this attraction must be completely contrary to nature and one’s being. It quite literally cannot be me. And so it must remain dissociated and unformulated.
However as culture changes, these not-me states are increasingly difficult to keep unformulated. This might be a stretch of Stern’s concepts, but no person in today’s electronically connected culture (no matter how many times the rabbis try to ban the Internet) is completely removed from queer culture. It is becoming increasingly difficult to keep a powerful attraction such as sexuality from remaining unformulated. The enactments will multiply and the rabbis, along with their followers will have no choice but to face what was relegated to the not-me and somehow come to terms with, at the very least, the bad-me.
One might be pessimistic and say, “Yes this change may well occur, but it could take two or three generations.” The authors are certainly not prophets (nor do they wish to be) but change today occurs so quickly that it truly is impossible to predict either the timeframe or the actual nature of the change. A recent article by Lefkowitz (2014), demonstrates how significantly many people within the Orthodox community are already changing. Lefkowitz appears, from his stated practice, to be an Orthodox Jew. Yet he also states he is not certain of the divine authorship of the commandments and is willing to pick and choose from the menu of Jewish rituals he will observe, without fear of divine retribution. He is not only comfortable with but clearly supports the accommodation of gay and lesbian students in day schools. As he states, he is not alone. Change is occurring. The challenges, however, are still there. The fractures in the Orthodox community are real and are not diminishing.
As psychoanalysts who are identified with the Orthodox Jewish community we need to be acutely aware of implied messages about referrals around gay or queer issues. If we allow ourselves to be open to and search for the potential not-me (in ourselves and our patients) that cannot be acknowledged, such as the sexual identity and orientation that by its definition appears to be beyond the pale, then we can begin to explore and address the “unbearable-ness” of the state. The challenge is to allow these various self states, some contradictory and incommensurable, to exist, to come into conflict and thus into our awareness. This will allow us to make whatever choices make sense with a fuller sense of who we are. And yes, one choice may well be to call Dr. Goldstein.