There are outpatient and hospital facilities for eating disorder patients, but until recently, there have been none suited specially for the Israeli modern Orthodox and ultra-Orthodox communities.
By JUDY SIEGEL-ITZKOVICHRabbi Shmuel Jablon(photo credit: JUDY SIEGEL-ITZKOVICH)Food is such an integral part of Jewish ritual that it would seem impossible for the young Orthodox and ultra-Orthodox to hide the fact that they are starving themselves due to eating disorders (EDs). Potentially fatal anorexia is apparently growing among the observant in Israel and the Diaspora.Even though these populations are less exposed to the secular media and models, which have been blamed for the surge of EDs in the general public, the pressures of shidduchim (finding a spouse through matchmaking) along with the same psychological factors as the general population- have spurred the phenomenon in the observant communities.Six months ago, an Orthodox rabbi and educator from Philadelphia – whose own teenager daughter suffered, but recovered, from nearly fatal anorexia – came on aliya and now serves as the executive director of Israel’s first-ever, non-profit out patient clinic for the treatment of the modern Orthodox and haredi sufferers of EDs.Since the summer of 2013, the Jerusalem clinic has treated – so far successfully – 20 sufferers, 18 of them teenage girls and young women and the rest boys and men.Mercaz Female (www.mercazfemale.org) is located in Jerusalem’s Kiryat Moshe quarter in a non-descript apartment building that, for privacy’s sake, lacks even a sign announcing its presence. The executive director is Rabbi Shmuel Jablon, the holder of rabbinical ordination from Chicago’s Hebrew Theological College, a master’s degree in education and former principal of the Torah Academy day school in Philadelphia.The founder of Mercaz Female and its clinical director is Batya Cohen- Thau (wife of Jerusalem Rabbi Tzvi Thau of Yeshivat Har Hamor) and a trained educational counsellor for 25 years. “She saw a tremendous need for such a facility, as there are few opportunities in general for treatment of EDs and nothing specifically for the observant, who often don’t feel comfortable in secular, therapeutic surroundings,” said Jablon. Her Orthodox professional staff come from the fields of psychiatry, medicine, clinical psychology, clinical social work, family and adolescent medicine, nutrition and art therapy.They receive regular continuing education from the staff of the Shahaf Institute, a secular treatment center in Tel Aviv.Jablon and his wife Rebecca (an occupational therapist by training) have five children aged 18 to one year; the oldest, Leah, is a survivor of anorexia from the age of 10 to 15 when they lived in Cleveland and Philadelphia who has been healthy since then. Today 157 centimeters tall, she weighed less than 35 kilos at her lowest point but has since reached normal weight and has abandoned her previous habits.“I FEEL very good now,” said Leah in a separate interview. “I discovered that from the age of eight, I suffered from obsessive-compulsive disorder (OCD). When I got on a plane, for example, I insisted that my chair had to be completely ‘decontaminated’ or I would have a tantrum. I was never fat, maybe only a few pounds overweight. But when I was taken to my pediatrician in Cleveland, he told me my body-mass index was ‘a bit high’ and that it would be advisable for me to exercise. My parents were very upset with him. My parents decided to switch me to a woman doctor who was more sensitive, but in any case, I felt I couldn’t eat.” Leah recalled.“My anorexia controlled my life for nearly five years. Five years of hunger pains, starvation, tears, and sweat. At nine years old I was quite an observant child – thoughtful and addicted to books, I read literature far more mature than my age. Therefore, once I was was told that my rapidly developing body was ‘maturing nicely.’ I relied on my knowledge to stop the maturation by diving into the world of anorexia. Meals were sparse, exercise was plentiful and the pounds melted away. I gained a sense of false confidence in my new emaciated body and flaunted it at every junction,” Leah recalled. “At age 14, I was knocking on death’s door, yet, through the efforts of an extraordinary medical and psychological team, I survived.”
When the family moved to Philadelphia, her OCD got worse after a second bout of anorexia. “It manifested itself when I was in uncomfortable situations. I couldn’t sit in class on a regular basis. I remember running out of the building in eighth grade.”As she went to a Jewish summer camp and had doctors’ appointments in June, she ate before the beginning of camp so she wouldn’t be rejected. But at camp, she stopped eating. “I lost nearly 5 kilos there. I caught swine flu and used it as an excuse for being thin, even though I had it for a very short time. I thought I made friends because I was thin. I never needed new clothing from when I wore a children’s size in seventh grade until 11th grade. I also exercised compulsively.”In eighth grade, she developed gastroparesis, a medical condition of delayed gastric emptying in which the food remains in the stomach for an abnormally long time.Her parents had to take her to the Children’s Hospital of Philadelphia many times. “Altogether, I underwent 18 different medical procedures, including the insertion – twice – of a gastric pacemaker and of a naso-gastric tube into my stomach three times. I also had total parenteral nutrition – a drip to get fats, proteins and other things for nutrition into a vein, five times a week,” said Leah. I didn’t know anybody else with anorexia, but I had convinced myself that it was a physical illness I suffered from, so I belonged in the hospital. I was never bulimic; sometimes I wished I could eat a lot and vomit, because then at least I would get some food. I sometimes unhooked my feeding tube at the hospital; a nurse caught me in the act and transferred me to an eating-disorder ward.” Cognitive behavioral therapy was of great help with the OCD.Her siblings would “try to avoid me. But I know my anorexia deeply upset them.” Finally, around the age of 15, while she was receiving inpatient treatment at the Renfew Center in Philadelphia she decided she “wanted my life back. I had to be perfect in some way, so I abandoned not eating and returned to obsessive behavior regarding school and academic work. I was released from the inpatient center because I had started eating again. Even after Renfrew, I continued with outpatient therapy.”She knows that for a fifth of all anorexics, the condition is fatal. “I was lucky enough to live. G-d chose to save that one little girl struggling to live in a world of emaciated models, embellished diet techniques and 100-calorie meal plans. I cannot stress enough the importance of eating disorder treatment. Without it, I would certainly not be alive today. Treatment allowed me to graduate high school with honors, make aliya with my family and to look forward to studying psychology here in Israel. I hope, G-d willing, to help others struggling with eating disorders."Prior to making aliya and studying at Midreshet HaRova in Jerusalem, Leah graduated from a religious high school in Philadelphia with excellent grades. She is extremely open about her eating disorder and has given talks about it at high schools and other places where peers will listen.As an Israeli, she will do national service and hopes she will be able to speak regularly to teenagers about avoiding eating disorders.Leah said that anorexia and bulimia are becoming “more common in the haredi and national religious communities abroad and in Israel.When men are offered a shidduch, the first thing many ask for is the girl’s height, weight and dress size.This is a more powerful an influence on the observant than TV, the Internet and models, as they are less exposed to this,” Leah noted. “In my case, I was not affected by the mass media.”She is “not afraid anorexia will come back. Now that I have been sharing my story, including the Mercaz Female and other websites, I understand the importance of life and what EDs can do to you. I enjoy living. I remember what I missed.When I tell my personal story, I feel I am helping others. Eventually I would like to study clinical psychology and work in the field of eating disorders.”HER FATHER, Shmuel, noted that eating disorders impact the whole family. “That’s why, at Mercaz Female, we have family counseling sessions as well as individual ones for the patients,” he said. “Rabbanit Thau wanted everything to be provided at the highest level of professionalism and with a multidisciplinary approach.” So far, patients have come not only from Jerusalem but also from Gush Etzion and Ashkelon.The non-profit organization tries to raise funds to treat the needy, but as the intensive treatment ranges from a minimum of NIS 3,000 to NIS 9,000 a month, those who can’t afford therapy often have to be turned away. Because of the severity of these orders, treatment normally lasts one to four years. Inpatient care for ED patients is covered by the health basket, but not those treated in the community.Mercaz Female is seeking philanthropic sponsors, including those who can donate $1,800 for one patient’s intensive treatment for one month; $3,600 to sponsor an intensive educational program for staffs of schools; and $21,600 to cover the cost of one patient’s intensive treatment for a year.“We frequently apply for grants from foundations and other sources. I think I made 25 such applications last month,” said Jablon. “But we are also looking for cooperation with the four public health funds, as treatment in the community can prevent hospitalization of ED patients in much more severe condition,” said the religious Zionist rabbi. “In any case, the reform in psychiatric care – with the health funds taking over care for psychiatric patients from the Health Ministry – begins in July.”Although the observant community has for years been very mum about discussing eating disorders, even the haredi media have begun to discuss it, at least in English. “This is important, because early intervention is critical,” the Religious Zionist rabbi noted.He is upset about reports that young religious men are putting stress on weight before accepting potential dates. “There are those, even where there is strict separation between men and women, who have the bizarre notion that their shidduch has to be thin. Separation is supposed to encourage non-objectivation of women, that they would not be treated solely as objects of physical beauty but rather to have beautiful souls – a complete person.Even without being exposed to the media, there are religious Jews with psychological, genetic and emotional factors that can lead to eating disorders.The modern Orthodox and haredi communities have many of the same challenges that the secular community has.”The Mercaz Female center consists of four rooms at the ground floor.Shades and drapes preserve privacy from the outside, and the secretaries try to schedule appointments so patients don’t see each other. One room is for art therapy, and Jablon holds up a silhouette of a normal- weight female made with gluedon pieces that one patient made.In treatment sessions, the Orthodox therapists stress the spiritual and religious aspects of life – including the requirement to take care of one’s health (Venishmartem me’od lenafshoteichem).Pikuah nefesh – saving lives – is a central commandment in Judaism. “When Jewish values are stressed, patients can be persuaded that they have to observe them and have something to live for,” said Jablon.As major fasts on Yom Kippur and the ninth of the Hebrew month of Av, as well as several minor fasts throughout the year, can pose a serious problem for anorexics, therapists consult with rabbis who are likely to prohibit fasting. Rabbi Shlomo Aviner – a leading Religious Zionist yeshiva head in Jerusalem and Beit El with whom Jablon has been close and whom he has consulted about Leah – called her when she was in treatment to tell her not to fast on Yom Kippur.As for the teenage boys and young men that the center has treated so far, Jablon hypothesizes that the problem may have come from OCD connected to religious observance, depression, perfectionism or wanting to be accepted by the Israel Defense Forces and being too heavy for elite units.Asked if he and his wife have any worries that Leah, healthy for three years, might regress, Jablon said: “I’m always worried that those with ED could go back to it, but in her case, I really believe she is over it. She is so invested in what she wants to do and helping others who have gone through what she did that I don’t believe she will slide back.”
