Based on therapeutic work and research carried out in a psychiatric clinic in Israel that specializes in the Jewish Ultra-Orthodox community, we suggest a culturally adapted narrative paradigm for the understanding and treatment of mental disorders. We analyze five stories of illness to show how individual distress is constructed as a dramatic narrative inspired by shared cultural symbols and enacted in specific interpersonal and social contexts. The proposed model is grounded in mental illness narratives told by anti-heroes, the patients, who are trapped in relationships with non-human figures. The therapeutic interventions aim to help them find and exercise alternative plots that adhere to common cultural themes in their society, in which they become active agents. Culturesensitive ‘reading’ of such narrativization processes, combined with strategic psychological considerations, is important for successful therapeutic efforts in cross-cultural settings, and also aids in the creation of an empathic attitude and a therapeutic alliance.
Aumada, J. (1994). Interpretation and creationism. International Journal of Psychoanalysis, 75(4), 695–707.
2.
Banks, C. G. (1992). Culture in culture-bound syndromes: The case of anorexia nervosa. Social Science and Medicine, 34, 867–884.
3.
Bergin, A. E. (1980). Psychotherapy and religious values. Journal of Consulting and Clinical Psychology, 48(1), 95–105.
4.
Bilu, Y. (1985). The taming of the deviant and beyond: An analysis of Dybbuk possession and exorcism in Judaism. The Psychoanalytic Study of Society, 11, 1–32.
5.
Bilu, Y. , & Goodman, Y. (1997). What does the soul say? Metaphysical uses of facilitated communication in the Jewish ultraorthodox community. Ethos, 25(4), 375–407.
6.
Bilu, Y. , & Witztum, E. (1993). Working with Jewish ultra-orthodox patients: Guidelines for a culturally sensitive therapy. Culture, Medicine and Psychiatry, 17, 197–233.
7.
Bilu, Y. , & Witztum, E. (1994). Culture sensitive therapy with ultra-orthodox patients: The strategic employment of religious idioms of distress. Israel Journal of Psychiatry, 31(3), 170–182.
8.
Bilu, Y. , & Witztum, E. (1996). The transmigration of Emperor Titus: Religious idioms in the construction and alleviation of distress in a Jewish ultraorthodox patient. British Medical Anthropology Review, 3(1), 16–26.
9.
Bilu, Y. , Witztum, E., & Van der Hart, O. (1990). Paradise regained: ‘Miraculous healing’ in an Israeli psychiatric clinic. Culture, Medicine and Psychiatry, 14(1), 105–127.
10.
Bruner, J. (1990). Acts of meaning. Cambridge, MA: Harvard University Press.
11.
Buchbinder, J. , Bilu, Y., & Witztum, E. (1997). Ethnic background and antecedents of religious conversion among Israeli Jewish outpatients. Psychological Reports, 8, 1187–1202.
12.
Buchbinder, J. T. (1994). The professional credo of an ultra-orthodox psychotherapist. Israel Journal of Psychiatry, 31(3), 183–188.
13.
Butler, M. H. , & Harper, J. M. (1994). The divine triangle: God in the marital system of religious couples. Family Process, 33(3), 277–286.
14.
Csordas, T. J. (1983). The rhetoric of transformation in ritual healing. Culture, Medicine and Psychiatry, 7, 333–375.
15.
Daie, N. , & Witztum, E. (1991). Short-term strategic treatment in traumatic conversion reactions. American Journal of Psychotherapy, 45(3), 335–347.
16.
Dow, J. (1986). Universal aspects of symbolic healing: A theoretical synthesis. American Anthropologist, 88(1), 56–69.
17.
Eisenberg, L. (1988). The social construction of mental illness. Psychological Medicine, 18, 1–9.
18.
Ellis, D. (1980). Psychotherapy and atheistic values: A response to A. E. Bergin’s ‘Psychotherapy and religious values.’Journal of Consulting and Clinical Psychology, 48(5), 635–639.
19.
Finn, M. , & Gartner, J. (Eds.). (1992). Object relations theory and religion. Westport, CT: Praeger.
20.
Garro, L. C. (1994). Narrative representation of chronic illness experience: Cultural models of illness, mind, and body in stories concerning the temporomandibular joint (TMJ). Social Science and Medicine, 38(6), 775–788.
21.
Gergen, K. J. , & Gergen, M. M. (1988). Narrative and the self as relationship. In L. Berkowits (Ed.), Advances in experimental social psychology(pp. 17–56). San Diego, CA: Academic Press.
22.
Gergen, M. M. (1992). Life stories: Pieces of a dream. In G. C. Rosenwald & R. L. Ochberg (Eds.), Storied lives: The cultural politics of self-understanding(pp. 127–144). New Haven, CT: Yale University Press.
23.
Goldberg, H. (1990). The Zohar in Southern Morocco: A study in the ethnography of texts. History of Religions, 29, 233–258.
24.
GonÁalves, O. F. (1995). Cognitive narrative psychotherapy: The hermeneutic construction of alternative meanings. In M. J. Mahoney (Ed.), Cognitive and constructive psychotherapies: Theory, research and practice(pp. 139–162). New York: Springer.
25.
Good, B. , Hererra, H., Good, H., & Cooper, J. (1985). Reflexivity, countertransference and clinical ethnography: A case from psychiatric cultural consultation clinic. In R. Hahn & A. Gaines (Eds.), Physicians of western medicine. Dordrecht, The Netherlands: Reidle.
26.
Goodman, Y. (1997). The exile of the broken vessels: Reality construction and therapeutic discourse at Jewish ultraorthodox settings for the treatment of the mentally disturbed in Israel. PhD dissertation, The Hebrew University of Jerusalem, Jerusalem.
27.
Greenberg, D. , & Witztum, E. (1991). Problems in the treatment of religious patients. American Journal of Psychotherapy, 45(4), 554–565.
28.
Greenberg, D. , & Witztum, E. (1994). The influence of cultural factors on obsessive-compulsive disorder: Religious symptoms in a religious society. Israel Journal of Psychiatry, 31(3), 211–220.
29.
Grisaru, N. , Budowski, D., & Witztum, E. (1997). Possession by the ‘Zar’ among Ethiopian immigrants in Israel: Psychopathology or culture bound syndrome?Psychopathology, 30, 223–233.
30.
Haley, J. (1963). Strategies of psychotherapy. New York: Grune & Stratton.
31.
Heilman, S. C. , & Friedman, M. (1991). Religious fundamentalism and religious Jews. In M. E. Marty & R. S. Appleby (Eds.), Fundamentalisms observed. [The Fundamentalism Project, Vol. 1.] Chicago, IL: University of Chicago Press.
32.
Heilman, S. C. , & Witztum, E. (1994). Patients, chaperons and healers: Enlarging the therapeutic encounter. Social Science and Medicine, 39(1), 133–143.
33.
Heilman S. C. , & Witztum, E. (1997). Value-sensitive therapy: Learning from religious patients. American Journal of Psychotherapy, 51, 522–541.
34.
Hertzfeld, M. (1986). Closure as cure: Tropes in the exploration of bodily and social disorder. Current Anthropology, 27(2), 107–120.
35.
Hinton, L. , & Kleinman, A. (1993). Cultural issues and international psychiatric diagnosis. In J. A. Costa e Silva & C. C. Nadelson (Eds.), International review of psychiatry(pp. 111–129). Washington, DC: American Psychiatric Press.
36.
Jones, J. W. (1991). Contemporary psychoanalysis and religion: Transference and transcendence. New Haven, CT: Yale University Press.
37.
Keyes, C. (1985). The interpretive basis of depression. In A. Kleinman & B. Good (Eds.), Culture and depression(pp. 153–174). Berkeley, CA: University of California Press.
38.
Kirmayer, L. J. (1993). Healing and the invention of metaphor: The effectiveness of symbols revisited. Culture, Medicine and Psychiatry, 17, 161–195.
39.
Kirmayer, L. J. (1999). Broken narratives: Clinical encounters and the poetics of illness experience. In C. Mattingly & L. Garro (Eds.), Narratives of illness and healing. Berkeley, CA: University of California Press.
40.
Kleinman, A. (1980). Patient and healers in the context of culture: An exploration of the borderland between anthropology, medicine and psychiatry. Berkeley, CA: University of California Press.
41.
Kleinman, A. (1988). The illness narratives: Suffering, healing and the human condition. New York: Basic Books.
42.
Kleinman, A. , & Kleinman, J. (1985). Somatization: The interconnections in Chinese society among culture, depressive experience and the meaning of pain. In A. Kleinman & B. Good (Eds.), Culture and depression(pp. 429–490). Berkeley: University of California Press.
43.
Levine, R. E. , & Gaw, A. C. (1995). Culture-bound syndrome. In R. D. Alarcon (Ed.), Cultural psychiatry(pp. 523–536). [The Psychiatric Clinics of North America, Vol. 18, No. 3.] Philadelphia, PA: Saunders.
44.
Lewis-Fern·ndez, R. , & Kleinman, A. (1995). Cultural psychiatry: Theoretical, clinical and research issues. In R. D. Alarcon (Ed.), Cultural psychiatry(pp. 433–448). [The Psychiatric Clinics of North America, Vol. 18, No. 3]. Philadelphia, PA: Saunders.
45.
Littlewood, R. (1983). The antinomian Hasid. British Journal of Medical Psychology, 56, 67–78.
46.
Mann, J. (1973). Time-limited psychotherapy. Cambridge, MA: Harvard University Press.
47.
Marty, M. E. , & Appleby, S. R. (Eds.). (1993). Introduction: A sacred cosmos, scandalous code, defiant society. In Fundamentalism and society – Reclaiming the sciences, the family and education. [The Fundamentalism Project, Vol. 2.] Chicago, IL: University of Chicago Press.
48.
Mattingly, C. (1994). The concept of therapeutic ‘emplotment.’Social Science and Medicine, 38(6), 811–822.
49.
McAdams, D. P. (1988). Power, intimacy and the life story – Personological inquiries into identity. New York: The Guilford Press.
50.
McLeod, J. (1997). Narrative and psychotherapy. London: Sage.
51.
Meichenbaum, D. (1995). Changing conceptions of cognitive behavior modification. In M. J. Mahoney (Ed.), Retrospect and prospect in cognitive and constructive psychotherapies: Theory, research and practice(pp. 20–26), New York: Springer.
52.
Minuchin, S. , Rosman, B. L., & Baker, L. (1978). Psychosomatic families: Anorexia nervosa in context. Cambridge, MA: Harvard University Press.
53.
Nichter, M. (1981). Idioms of distress: Alternatives in the expression of psychosocial distress: A case study from south India. Culture, Medicine and Psychiatry, 5, 379–408.
54.
Obeyesekere, G. (1990). The work of culture: Symbolic transformations in psychoanalysis and anthropology. Chicago, IL: University of Chicago Press.
55.
Omer, H. (1994). Narrative reconstruction. In Critical interventions in psychotherapy: From impasse to turning point(pp. 44–67). New York: Norton.
56.
Parsons, C. D. (1984). Idioms of distress: Kinship and sickness among the people of the kingdom of Tonga. Culture, Medicine and Psychiatry, 8, 71–93.
57.
Parsons, C. D. , & Wakeley, P. (1991). Somatic responses to distress in everyday life. Culture, Medicine and Psychiatry, 15, 111–132.
58.
Rabkin, R. (1977). Strategic psychotherapy. New York: Basic Books.
59.
Russell, R. L. , & van den Broek, P. (1992). Changing narrative schemas in psychotherapy. Psychotherapy, 29(3), 344–354.
60.
Sarbin, T. (1986). Narrative as a root metaphor for psychology. In T. Sarbin (Ed.), Narrative psychology: The storied nature of human understanding(pp. 3–21). New York: Praeger.
61.
Scholem, G. (1974). Kabbalah. Jerusalem: Keter.
62.
Sluzky, C. (1992). Transformations: A blueprint for narrative changes in therapy. Family Process, 31(3), 217–230.
63.
Spence, D. P. (1982). Narrative truth and historical truth: Meaning and interpretation in psychoanalysis. New York: Norton.
64.
Spiro, M. E. (1987). Religious systems as culturally constituted defense mechanism. In B. Kilborne & L. L. Langness (Eds.), Culture and human nature(pp. 145–160). Chicago, IL: University of Chicago Press.
65.
Swartz, L. (1985). Anorexia nervosa as a culture-bound syndrome. Social Science and Medicine, 20, 725–730.
66.
Trachtenberg, J. (1974). Jewish magic and superstition: A study in folk religion. New York: Atheneum.
67.
Turner, V. (1964). An Ndembu doctor in practice. In A. Kiev (Ed.), Magic, faith and healing(pp. 230–263). New York: Free Press.
68.
Van der Hart, O. (1983). Rituals in psychotherapy. New York: Irvington.
69.
Verhulst, J. , & Tucker, G. (1995). Medical and narrative approaches in psychiatry. Psychiatric Services, 46(5), 513–514.
70.
Watkins, J. G. , & Watkins, H. H. (1997). Ego-states: Theory and therapy. New York: Norton.
71.
White, M. , & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.
72.
Winnicott, D. W. (1958). Transitional objects and transitional phenomena. In Collected papers. London: Tavistock.
73.
Witztum, E. , Buchbinder, J., & Van der Hart, O. (1990). Summoning a punishing angel: Treatment of a depressed patient with dissociative features. Bulletin of the Menninger Clinic, 54(4), 524–537.
74.
Witztum, E. , Grisaru, N., & Budowski, D. (1996). Zar syndrome in Ethiopian immigrants in Israel: Cultural and clinical aspects. British Journal of Medical Psychology, 69, 207–225.
75.
Young, A. (1976). Internalizing and externalizing medical belief system: An Ethiopian example. Social Science and Medicine, 10, 147–156.
76.
Young, A. (1982). The anthropologies of illness and sickness. Annual Review of Anthropology, 11, 257–285.
77.
Zimmerman, J. , & Dickerson, V. C. (1994). Using a narrative metaphor: Implications for theory and clinical practice. Family Process, 33(3), 233–245.
