By Esther Perkal
Eating disorders were long regarded as a non-issue in Israeli charedi society. A study conducted in 2009 by Ben Gurion University contrasting psychological perceptions within the secular and religious sectors even revealed that the more religious a group, the lower the number of eating disorder (ED) cases.
Yet in the past decade, “These numbers have changed, and in a major way,” says Professor Rael Strous, Director of the Mental Health Department at Mayanei Hayeshua Medical Center. “Today’s chilling reality exposes a very different story with new cases of eating disorders revealed daily among charedi youth, even among yeshivah bachurim.”
Meirav Shimoni, 42, is the head nurse in Maayanei Hayeshua’s Eating Disorders and Pediatric Psychiatry Units. Married and a devoted mom to 3 boys, her passion has always been medicine and health.
“I always felt an affinity for nursing and healthcare, and as a teen, even volunteered for MDA. I never had a doubt that, one day, I’d enter the medical field.”
Her love of people and innate desire to give led her to pursue a career in nursing, and 18 years ago, Meirav took her first job as a junior nurse in the Eating Disorders Department at Tel Hashomer Hospital.
In the course of her work, Meirav, who grew up in an Orthodox home, swiftly discovered that eating disorders, like any mental illness, do not distinguish among demographics, and that the Orthodox community is far from immune to diet and health misconceptions, the pressure to be thin, and the biological and environmental factors contributing to the rising number of cases. No matter how parents try to shelter or shield their children, the ideals of thinness and perfection seep into their lives. Eating disorders in the Jewish community manifest themselves similarly to those in the secular world and are potentially life-threatening. What did differ, she discovered from years of working with young women in the ED unit, was the impact that Orthodox culture has upon the treatment and recovery process. This was one of her chief motives in joining Mayanei Hayeshua’s team three years ago and helping to found its pediatric ED department.
An article published by the Washington Times exposes that eating disorders are “underreported among Orthodox Jewish women…as many families are reluctant to acknowledge the illness at all and often seek help only when a girl is on the verge of hospitalization.” Reluctance to acknowledge an eating disorder may be impacted by stigma of mental illness in Orthodox communities, as well as the importance of being thin for shidduchim. As in the general community, Jewish Orthodox girls may adopt an eating disorder in attempt to achieve what they perceive as perfection and control. Food, which is also central to Jewish culture and prepared in abundance for Shabbos and Yom Tov, can cause preoccupation with food and exacerbate eating issues for those already struggling.
While the stigma surrounding mental illness may cause families to hesitate before appealing for help, individuals and groups within the Orthodox community are taking concerted action to address mental health issues. One party spearheading the battle in the charedi world against mental illness in general, and eating disorders specifically, is Mayanei Hayeshua Medical Center.
When Mayanei Hayeshua opened thirty years ago in the charedi enclave of Bnei Brak, it was the first of its kind – a religious maternity hospital catering to the specific needs and sensitivities of the religious community. Over the past decades, the hospital expanded into a state-of-the-art, full-service hospital, still primarily accommodating the religious community. It would take close to twenty years before the hospital opened its mental health center, a delay that drew largely from the religious stigma against mental health institutions. Yet what began as a modest outpatient clinic swiftly blossomed into a towering seven-story edifice with a full in-patient wing.
Psychiatric wing administrative director Dr. Tzippy Burenshtein relates that despite the obvious need, the hospital administration was wary of opening a pediatric inpatient department for fear that no one would come. The turning point occurred one erev Rosh Hashanah when a distraught father entered the emergency room with his daughter who was in dire need of treatment. “Please admit her!” he implored. He’d heard too many stories of chareidi teens treated in secular hospitals who’d adopted detrimental behaviors and ultimately abandoned Yiddishkeit.
One of the next patients was a young woman whose elder sister had suffered from an eating disorder and been admitted to a hospital where a secular staff member had alienated her from her parents and persuaded her to reject a religious lifestyle. When their next daughter began manifesting symptoms of an eating disorder, the parents insisted on bringing her to Mayanei Hayeshua.
“The cases that we’re encountering are very serious, some bordering on life and death,” Meirav Shimoni expresses. “The work is exceedingly challenging, but simultaneously stimulating and inspiring. In the course of my rounds, I do all I can fill my young patients’ lives with light, love and happiness. It’s easy to see how much that extra smile and good word means to them.
“And I want to emphasize that it’s not just me. All the staff members here are amazing, going above and beyond to ensure that every patient feels comfortable and cared for. This place has neshamah, spirit, and not just a neshamah, but a neshamah yeseirah!”
At present, Mayanei Hayeshua’s Mental Health Department treats over 25,000 Israeli and foreign patients annually. The state-of-the-art wing houses dozens of inpatient departments and outpatient clinics, from Eating Disorders to Cognitive Behavioral Therapy, with its unique approach to mental health issues consistent with the hospital’s core commitment to the sanctity of human life and halachah, including Shabbos, kashrus and gender separation. Chaim Fachler, Director of International Resources and Development, explains that “People don’t realize how traumatic it is when hospitals don’t account for cultural sensitivities.”
According to Professor Strous, cultural sensitivities matter for other reasons, too, as the context for diagnosis may differ between religious and non-religious patients. He offers the classic example of handwashing, which can be a religious ritual or a symptom of mental illness.
Dr. Tzofia Laufer, psychiatrist and Deputy Director of the Eating Disorders Department at Mayanei Hayeshua, explains that formerly, charedi parents of children with eating disorders would often forego treatment when the road to recovery involved extended hospitalizations in places antithetical to a Torah lifestyle. Mayanei Hayeshua, however, maintains a separate ward for eating disorders, enabling treatment to proceed without concern. Commonly, young women with eating disorders were also victims of serious abuse, which compels treatment not only for their condition, but for the trauma that evoked it.
From a medical perspective, the hospital is an all-in-one facility with a dedicated staff trained in multidisciplinary healing. A young woman admitted for anorexia will be seen and treated by a pediatrician, psychiatrist, social worker, nutritionist, and nurse all in the same complex, all of whom are committed to treating the condition and resolving the resulting educational, social, legal and familial ramifications.
When asked to recount one of the unforgettable moments in her career, Meirav doesn’t hesitate before replying. “It was a day not long ago when Shira* walked in pushing her infant son in a stroller. When she was 17 years old and in 12th grade, Shira was hospitalized in the ED unit in a bad state. She suffered from severe anorexia and bulimia and at five-foot-four, weighed just about eighty pounds. She was with us in the unit for an extended period of time, in the course of which we became very close; and following a comprehensive treatment plan, she rehabilitated and graduated to our outpatient clinic. Shira was so awed and inspired by what she observed and experienced here in the hospital that she enrolled in nursing school as her way of giving back to the professionals who facilitated her recovery. When she got married last year, she invited the entire faculty to her wedding, and we all came and rejoiced with her. Just a few weeks ago, she came back to visit again with her newborn son! For me personally, this was a landmark moment, concrete evidence of how we have the opportunity to transform people’s lives for the better.”
The success rate of Mayanei Hayeshua’s mental health initiatives is unparalleled in Israel, and possibly the world. The national rate of relapse and repeated hospitalization after 30 days averages 19- 20% in other hospitals, while at Mayanei Hayeshua, it is less than 2%. “That’s an astounding success rate,” says Fachler. One reason, he explains, is that the hospital perceives itself as a rehab center that concerns itself not only with treating a patient, but also with reintegrating him/her into school, community and family. The hospital likewise boasts a Family Therapy Unit, which facilitates families whose parent/s struggle with mental issues.
Meirav shares another heartwarming case. Rikki* was brought into the hospital’s pediatric psychiatric unit after suffering a psychotic attack. The girl, who was only eleven at the time, derived from a disadvantaged background, and when one nurse in the hospital got wind of the fact that her bat mitzvah was coming up and Rikki’s family couldn’t afford the affair that the girl was longing for, she took matters into her own hands. Recruiting her colleagues at Mayanei Hayeshua to the task, she rented a hall, caterer, musician and party-planner, and also made arrangements for a gown, hair and makeup for the birthday girl. “It was a magnificent affair that meant so much to Rikki, her fellow patients, family, and the entire staff,” Meirav recalls with a radiant smile.
Recently, the prestigious Frontiers magazine featured groundbreaking research by Mayanei Hayeshua’s Eating Disorders Unit regarding virtual online home-based treatment for young women with eating disorders. With the outbreak of Covid-19 in Israel and ensuing lockdowns, there was an unprecedented need to find immediate solutions to maintain continuity of treatment and preserve the achievements of inpatient care for those previously hospitalized in Mayanei Hayeshua’s ED department.
Many parents rejected the notion of leaving their daughters fully hospitalized without options for visitation, and the Health Ministry simultaneously rejected a day-hospital format. This need led the department’s team to seek channels for long-distance online treatment, which not only unconventional in mental health care, but also unfamiliar and largely eschewed by the charedi population. Accounting for the sector’s minimal use of internet and digital devices, the acceptance of online therapy represented a revolutionary shift. In a resounding success, Mayanei Hayeshua’s ED department developed an innovative virtual model for online therapy that adhered to religious values, societal mores, and was, moreover, endorsed by Rabbanim.
Right at the onset of the Covid pandemic, Fachler fundraised to purchase computers and iPads to help former patients maintain their treatment protocol at home. Many were also outfitted with a digital bracelet that monitored their systems and sent information directly to the department 24/7. The staff was thus alerted to any changes in heartbeat or blood pressure indicative of a lapse in care.
Professor Strous expresses that “With the support of the community’s civic and religious leaders, we are facing down the stigma of mental health. No community is immune to the mental health challenges prevalent in our greater society. Cultural sensitivity for all our patients is a major priority for us, and we’re determined to eradicate the emotional fragility that once plagued families regarding mental health issues. Before we opened our facility, most families were too afraid to seek help from other clinics. Now that we operate openly in the city center, demand for our services is at a peak.”