Not sure if this is the right place to ask this...

[dicentra spectabilis]

Looking for a crash course in Judaism, especially about possible ways that Jewish beliefs and/or practices could affect the treatment of a patient. I'm almost entirely ignorant in this area. I just want something to help me (and my coworkers) understand a little about how Jewish beliefs could affect treatment, and keep from inadvertently giving offense. And I work again tomorrow morning at 0630. This is an inpatient psychiatric commitment. The person of whom I speak was brought in involuntarily by the police, and committed. Our treatment schedule runs 7 days per week, no days off. The criteria for admission are that the person is deemed to be a danger to themselves or others, usually either by actually expressing suicidal or homicidal ideation, or by exhibiting psychosis of a severity that impairs their judgement enough to make them a danger.

I'm curious as to an explanation of what these are and why they're important:

kosher, especially a "kosher kitchen" and what makes a food or kitchen not kosher
prayer scarf (with a bunch of leather straps?)
small very thick book with hebrew writing embossed on the front (holy book?)


What is the Jewish prayer "ritual"?

What is the Jewish view on recreational drug use? Alcohol? Mental illness? Suicide? Sex? Modesty? Indecent exposure? Male vs. female roles?

I realize there are probably lots of different types of Judaism, like there are lots of different types of Christianity, and I'm sorry, I don't have any more information. I'm looking for input so I can provide culturally sensitive care in a psychiatric hospital. I'll be back to check morning before I go back to work, but I'll be back later too.

I've read the FAQs, but they mostly made me think of more questions. If I had the time (and I will later) I'd do a lot more of my own research, but I worked today, had lots of company over for Easter tonight, and I have to be back to work in the morning.

[Henaynei]

I'm curious as to an explanation of what these are and why they're important:

kosher, especially a "kosher kitchen" and what makes a food or kitchen not kosher

I am assuming that this person is orthodox and thus keeps strictly kosher. These are laws mandated by G-d on what is and is not acceptable to eat. Thus things that do not conform to the laws of kashrut/keeping kosher are not even considered food. These laws also cover how the food is handled, cooked, preserved..... what utensils/euipment/appliances are used in it's preparation (they can't have been used on or to prepare unkosher items).

Kosher means acceptable according to scriptural and traditional mandates. This is a rather involved process and method and there is NO WAY anything *prepared* in your institutional kitchen will be kosher.


I suggest that you contact someone at a synagogue in your area and, without breaking confidence of course, explain you have a patient who "keeps kosher" and how might they suggest you can provide food for them. They should be able to tell you where such can be found.


An even better idea is to have the family bring in stuff already prepared that can be kept in your refrigeration (double wrapped to preserve the kosher status) and then heated in an oven (again double wrapped - don't open the wrapping until it is in front of your patient - "chain of custody" if you will in ensuring it's kosher status) - in your situation a microwave might not be a good suggestion as the kosher status is difficult to ensure - again the family can guide you in what will work.

prayer scarf

the Tallit or, probably, Tallis - prayer shawl - it is a holy item and must have the "strings" on the corners - it a very important part of the prayers your patient will likely want to do (perhaps as much as 3 times a day and at specific times)

(with a bunch of leather straps?)

Philactories or Tefillin - prayer boxes worn bound to the arm and around the forehead during prayer - also a very important part of the prayers - worn every day @ prayers except on the Sabbath


(having worked on a psych ward myself I'd urge, of course, that during the times that he is using these items (Tallis and Tefillin) for prayer he be visually supervised and that the items be kept secured when not in use - since you say he maybe a danger to himself)

small very thick book with hebrew writing embossed on the front (holy book?)

likely a Siddur - hebrew book of prayers - yes, holy and yes, specifically needed during prayers

What is the Jewish prayer "ritual"?

prayers are said traditionally 3 times a day and are lengthy: early morning/Shakrit, mid-day/Mincha and evening/Ma'ariv - the type of Judaism your patient follows and to what degree will dictate what of these he does

What is the Jewish view on recreational drug use?

pretty much the same as Christianity

Alcohol?

Alcoholism is not as pervasive a problem in the Jewish population as in the non-Jewish. There are exceptions of course. The excessive use of alcohol is not any more favored in Judaism than in Christianity. However, unlike much of Christianity the consumption of alcohol, specifically wine, is regular part of worship - specifically at meals on the Sabbath and any holy day. The blessing over the wine and the consumption of a glass of wine are part of what sets that day apart as holy. There is room, of course, to accomodate the issue of alcoholism and temptation - thus the barakh/blessing can be said over any *kosher* grape juice - this is what is usually done in prisons etc.

Mental illness? Suicide?

The rabbi at the synagogue/temple from which this man comes could best answer these - and provide the most sensitive answers

Sex?

monogamous hetrosexual marital - is to be enjoyed as given by the Creator for enjoyment and procreation a fulfillment of His command to be fruitful - the inability to produce children is seen in some traditions as embarassing, at the least.

Modesty? Indecent exposure?

A very large issue. Traditionally orthodox men do not touch any woman other than their wives. Women traditionally cover for modesty's sake wearing sleeves that cover the elbow, skirts that cover the knee while sitting - though often to the ankle - and colars that cover to the clavical - no splits at the neckline or hem of the skirt - hose are also worn and her head covered, by a wig or scarf. A man wears a shirt with sleeves - short sleves can be permitted depending on the tradition, and long pants - he considers himself exposed if he is not wearing his kippah/yalmukah/skuppcap during his waking hours

Male vs. female roles?

In the orthodox tradition these are fairly strongly defined - though somewhat flexible. The man is the head of house and the woman is responsible for the keeping of a kosher home and all that entails,she may or maynot work outside the home as well - again, the local rabbi can be an invaluable resource in understanding the traditions and mores under which your patient lives.

I realize there are probably lots of different types of Judaism, like there are lots of different types of Christianity, and I'm sorry, I don't have any more information.

You do honor to your profession, your patient and your G-d by asking and seeking answers to these questions!


I'm looking for input so I can provide culturally sensitive care in a psychiatric hospital. I'll be back to check morning before I go back to work, but I'll be back later too.

We would be honored to help in any way we can.....

Bear in mind the adage: "Where there are 2 Jews, there are 3 opinions!" - this is one reason I urge you to seek out your patient's rabbi as each community has nuances that can be very important.


I hope I have helped some.

b'Shalom
Henaynei

[Wags]

Thank you for your sensitivity and asking these questions ahead of time. I did a research paper on substance abuse in the Jewish Community a few years ago as part of a Social Work degree. Statistically Jews have a lower percentage of alcohol and illicit drug addiction, but they have a higher rate of perscription drug addiciton.


A great professional resource for you is:
JACS (http://www.jacsweb.org/) - Jewish Alcoholics, Chemically Dependant Persons and Significant Others They are a volunteer group, but the site has links to Jewish Rehab facilities.

[dicentra spectabilis]

Thank you both very much! I'll be back again tonight to check...

[Sephania]

To avoid being misunderstood by anyone else, I have deleted my post.

[Henaynei]

this patient is in a secular treatment center - I doubt they are qualified to deal with Kaballah one way or another :) that is something better dealt with by a rabbi :)

Personally, I see nothing but traditional orthodox in the description of the person in question :) kosher, tallit, siddur, tefillin - and then standard treatment questions re: attitudes toward drugs, sex, alcohol and gender roles - all to better understand someone of a different culture :) many of the same questions I'd ask if faced with a person from an oriental or hispanic culture, knowing that their worldview is different from my own :)

[dicentra spectabilis]

Religion is not a part of our program, although we can contact the hospital chaplain on behalf of the patient if they request a visit from a clergy person. This rarely happens, and the person in question answered "no" when asked if a clergy visit was desired. If the answer had been "yes," the chaplain would have contacted an approved clergy person from the patient's religion (has already signed confidentiality agreements, etc...) to come and visit at the facility. Patients may also have their own clergy visit, either during regular visiting hours (2 hours per day, 2 visitors at a time per patient) or by doctor's order outside of visiting hours. My concern is not to guide this person spiritually in any way, only to understand enough to at least avoid giving offense. And I enjoy being exposed to cultures different from my own, so now that my curiousity has been sparked, I'm interested in learning more. Not out of a desire to convert, just to increase understanding and knowledge. I'm easily fascinated.

The cafeteria manager, at least, is more familiar with kosher; they were able to get kosher frozen meals in by the case, so that problem is taken care of. Still curious about exactly what it means and why it's so important. The patient was perfectly willing to starve if we were unable to obtain kosher food for him, but did eat cereal and milk, and a bagel from our cafeteria. Why are those OK, but not the other stuff? Is it just because they were originally prepared elsewhere? What if we had toasted it in our cafeteria (don't know, wasn't there)? Would it still be kosher?

My favorite question is "why?" Can you tell I drove my parents crazy when I was a child? I drive my professors crazy now.

[Mikhail]

Oy Vay!
No wonder he said no he probably thinks you are going to get a Priest to convert him.

Ask him if he wants a rabbi or his Rabbi contacted?
Regards,
Mikhail

[Henaynei]

Religion is not a part of our program, although we can contact the hospital chaplain on behalf of the patient if they request a visit from a clergy person. This rarely happens, and the person in question answered "no" when asked if a clergy visit was desired. If the answer had been "yes," the chaplain would have contacted an approved clergy person from the patient's religion (has already signed confidentiality agreements, etc...) to come and visit at the facility. Patients may also have their own clergy visit, either during regular visiting hours (2 hours per day, 2 visitors at a time per patient) or by doctor's order outside of visiting hours. I figured as much :) My concern is not to guide this person spiritually in any way, only to understand enough to at least avoid giving offense. And I enjoy being exposed to cultures different from my own, so now that my curiousity has been sparked, I'm interested in learning more. Not out of a desire to convert, just to increase understanding and knowledge. I'm easily fascinated. all worthy goals :) We are happy to try to answer any questions you may have :) The cafeteria manager, at least, is more familiar with kosher; they were able to get kosher frozen meals in by the case, so that problem is taken care of. The patient was perfectly willing to starve if we were unable to obtain kosher food for him, but did eat cereal and milk, and a bagel from our cafeteria. Why are those OK, but not the other stuff? Is it just because they were originally prepared elsewhere? What if we had toasted it in our cafeteria (don't know, wasn't there)? Would it still be kosher? You'd be suprised what you eat everyday that has been certified kosher. It is highly likely that both the cereal and milk were kosher (certified kosher as shown by them bearing one of the several "kosher" marks on the box/carton). The bagle may also have been kosher, not knowing more about how it was packaged and delivered I can't say, but it sounds like your patient is committed to kashrut (the practice of keeping kosher) and would not have eaten it otherwise. It is unlikely that he would consider it kosher if toasted on your equipment, although I can envision circumstances where it might be.

Your cafeteria manager is a keeper, to both understand the issues of kashrut and to be able to get in kosher foods that quickly! My favorite question is "why?" Can you tell I drove my parents crazy when I was a child? I drive my professors crazy now.Didn't you know?? "Why?" is a VERY Jewish question!!

Still curious about exactly what it means and why it's so important. There are three pillars of observance on which Judaism stands: Family purity, Sabbath keeping and Kashrut. For the turly Torah observant person these three are inviolate. Here we will only discuss Kashrut.

Firstly a food must come from the groups of permitted or Kosher foods listed in Leviticus 11 (http://bible.crosswalk.com/OnlineStudyBible/bible.cgi?passage=le+11&version=cjb&showtools=0) (read the whole chapter). Then those foods must be prepared in a manner that does nto invalidate their kosher status. The animal must be slaughtered in a very specific way - called the sh'keytah and by a person steeped in all the laws that concern kosher status - called a shokhet. After a through inspection that is more stringent by an order of magnitude above the USDA inspection (that which passes USDA may not necessarily pass a kosher inspection, but everything that passes a kosher inspection will easily pass a USDA inspection), the carcus is then processed (hung to allow all the blood to drain out and salted and soaked to remove all blood humanly possible) and packed to ensure that the kosher status is not violated by it coming in contact with something not kosher.

Then comes the preparation: Observant Jewish people do not mix milk/milk products with meat/meat products. This means that separate equipment and utensils are used as well as serving and eating items for either a meat or dairy meal. Additionally, one must wait a lenghty period between a milk and meat meal - traditions vary from 3-6+ hours.

An additional layer of challenge is the issue of items which don't carry a hecksher (kosher approval mark) but whose ingredient list might lead you to believe they are free from any forbidden foods. Not so, for there is the issue of the equipment on which the food was processed, prepared or packaged - even the packaging in qhich the food is placed. In today's manufacturing large plants quite often run batches of foods for different brands and different types on the same machinary - so that the potatoe chips you pick up from the grocery shelf may have been processed on the same equipment that the pork rinds were processed, and so on..... you can see the problem.....

This is why an observant Jewish person will not eat anything that does not have a hecksher. There are a plethora of kosher organizations who provide kosher inspection and oversight and each has their own registered hecksher. (note: the (R) you see on most all packages is NOT a hecksher, it is only a "registered trademark" for the brand name.

here is a partial list just for information purposes :)

http://www.seattlevaad.org/KosherSymbols.html

Now to add more issues to the situation: Passover is coming in about 4 weeks. Does the care plan anticipate yoru patient will be in your facility at that time?

[Henaynei]

Oy Vay!
No wonder he said no he probably thinks you are going to get a Priest to convert him.

Ask him if he wants a rabbi or his Rabbi contacted?
Regards,
MikhailI have to admit that was my reaction to that information as well.

May I suggest that after he has had a few days to settle in and get to know you that you bring this up again and make it very clear that you can get, a, or his, rabbi to be availble for him, not a christian clergy?

As a helath care provider, I know you are aware how confusing and overwhelming, even traumatic, the intake and assessment process can be for a paitent. A Jewish patient is very sensitive to the potential of exposrue to christian doctrine/clergy and in the hubub of the intake could very well not understood that he has access to a rabbi of his faith.... likely a reform or conservative rabbi will not do for this fellow.

[dicentra spectabilis]

At times, outside clergy are not terribly receptive to coming in. So we don't really push it. We ask the question, amongst 8 pages of other questions, and leave it at that. A month or so ago, we had a patient who was Jehovah's Witness, and all this person wanted was some literature/devotional material brought in. It took so many phone calls before we could just get someone to drop the stuff off at the front desk. Unfortunately, psychiatric illnesses still carry quite a stigma in some circles, even within the clergy.

Our facility is an acute treatment center. The goal stay is from 3-5 days. Basically, we just need to get them stable enough that they'll be safe in the community, then set them up with outpatient followup treatment. We do at times have patients who stay a month or more, and I know of one who stayed over 3 months. That's not the norm, and it's usually an issue of needing continued inpatient care. We have to find an appropriate long-term facility to send them to, whether for continued psychiatric treatment or substance abuse rehab.

Thank you for the explanations. Another question though: why would you automatically assume that "Would you like to request a visit from clergy?" would be Christian clergy? I take the word clergy to mean something along the lines of whoever's the head honcho in the local organization of your religion. Priest, pastor, rabbi, minister, etc...

[Henaynei]

Thank you for the explanations. Another question though: why would you automatically assume that "Would you like to request a visit from clergy?" would be Christian clergy? I take the word clergy to mean something along the lines of whoever's the head honcho in the local organization of your religion. Priest, pastor, rabbi, minister, etc... This is because of your Christian cultural vantage point (nothing wrong with that BTW, it's just the hill you're standing on;) ). In Christianity there are so many varied titles for the leaders of congregations and fiath communities and scores of breakdowns of titles within some of those that Christianity uses the term "clergy" to cover them all. In Judaism there is one title - rabbi, you either is or you isn't ;) - clergy is mostly seen as a Christian term. :)

[Wags]

Thank you for the explanations. Another question though: why would you automatically assume that "Would you like to request a visit from clergy?" would be Christian clergy? I take the word clergy to mean something along the lines of whoever's the head honcho in the local organization of your religion. Priest, pastor, rabbi, minister, etc...

If a person is already not clear headed - which would be the case if they are being admitted to your facility - then yes the term "clergy" would definately be equated with "chrisitan".

Christians have many different names for their religious leaders, so the term clergy is a good umbrella term. Since Jews only use one term - Rabbi - the "all inclusive" word clergy says christian religious leader to them.

[Velcro]

Henaynei wrote: You'd be suprised what you eat everyday that has been certified kosher. It is highly likely that both the cereal and milk were kosher

Yes! Including Hershey bars! I am sure this was by divine intervention! :wave: :amen:

* * * * * * *

Dicentra Spectabilis, Wow, do i ever appreciate what you are doing! I wish all in the medical field were as sensitive and thorough as you! Bless you!

[Wags]

This is because of your Christian cultural vantage point (nothing wrong with that BTW, it's just the hill you're standing on;) ). In Christianity there are so many varied titles for the leaders of congregations and fiath communities and scores of breakdowns of titles within some of those that Christianity uses the term "clergy" to cover them all. In Judaism there is one title - rabbi, you either is or you isn't ;) - clergy is mostly seen as a Christian term. :)

We were posting at the same time - guess great minds really do think alike. :D

[Henaynei]

We were posting at the same time - guess great minds really do think alike. :DLOL - yup :thumbsup:

[dicentra spectabilis]

So is there an umbrella term that would include both Christian and Jewish religious leaders? (And all the other religions' leaders?)

Thank you Velcro. I've received insensitive care myself, and I keep that always in my mind, how it made me feel, when I'm at work.

[visionary]

spiritual councellor????? totally generic term

[Henaynei]

So is there an umbrella term that would include both Christian and Jewish religious leaders? (And all the other religions' leaders?)
Not really - except "spiritual leader" - but even that sounds pretty new-agey to some ears ;) You can always ask their religious affiliation first, and then you will know the appropriate term to use :) or just offer "someone from your (church, synagogue, mosque, etc), or one of our clergy?"

[dicentra spectabilis]

Thanks again, everyone.