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Painful Rituals: Program Treats Eating Disorders in Observant Women

Just before sundown on a Friday evening, Rachel Nathanson turned on a lamp in her living room and recited the prayer traditionally said upon kindling Sabbath candles. Then she said the blessing over the wine, allowing herself a single sip of grape juice. She purposely skipped the blessing over the challah — “I don’t trust myself with all that bread,” she explained. She then proceeded to eat a fish filet, a small portion of applesauce and a handful of graham crackers; the menu had been planned days earlier.

It has been years since Nathanson, a 26-year-old geriatric social worker in New York, has felt comfortable at the communal Sabbath meals common among her peer group. She can’t stand not knowing in advance what will be served, and she can’t stand the thought of others watching her eat.

In 2005, Nathanson was diagnosed with the eating disorder bulimia nervosa, characterized by binging and purging, and with EDNOS — an acronym for “eating disorders not otherwise specified.” Her illness has also included instances of cutting and burning her own skin, which is why she avoids lighting candles.

Since her diagnosis, Nathanson has sought help at the Philadelphia and New York locations of the Renfrew Center, a for-profit network of eating-disorder clinics, which this spring launched a pioneering treatment track for observant Jewish women. In addition to a kosher meal plan, the program will address the unique stressors in the Orthodox world — for example, the anxieties that can accompany Sabbath and holiday meals and traditional Jewish matchmaking, or shidduchim. Clinicians are trained to be sensitive to such issues.

The introduction of Renfrew’s new track comes amid a burgeoning movement in the Orthodox community to increase awareness of eating disorders. In recent months, the Orthodox Union has come out with a short documentary on the subject, “Hungry to be Heard,” and has joined forces with Renfrew to organize Food, Body Image, and Eating Disorders in the Jewish Community — a daylong professional conference to be held June 7 at the Ramaz Middle School in New York. In addition, a team of researchers recently has begun to adapt for yeshiva day schools an eating-disorder prevention curriculum. And a support group for observant Jewish women with eating disorders formed in early May on Manhattan’s Upper West Side.

“Different organizations have put eating disorders on their priority list, and a certain momentum has built up over time,” said Manhattan psychologist and eating-disorder specialist Esther Altmann, referring to the new initiatives targeted at preventing and treating eating disorders among religious Jews. Most of those diagnosed with such disorders are teenage girls and young women, she said.

As a senior consultant to the Renfrew Center, Altmann helped develop the new program, which she called “a response to the increased awareness in the observant community that women with eating disorders require immediate professional intervention.”

In recent weeks, Renfrew inaugurated the track at its residential treatment facilities in Philadelphia and Coconut Creek, Fla., and at its non-residential program in New York City — with plans to extend it to any or all of its six other treatment facilities if there is demand. Over the years, Renfrew has launched other special programs for eating-disorder patients who abuse drugs and alcohol, those who have experienced physical and sexual abuse and those over the age of 30.

Since Renfrew opened its first facility 24 years ago in Philadelphia, the center has had observant Jewish patients. Up until now, they have attended sessions alongside a heterogeneous group of women. “When we would have an observant woman in the group, half of the session would be taken up explaining what a shidduch is, or answering questions like, ‘What do you mean that you don’t have sex before you get married?’” said Cindy Shore, Renfrew’s assistant vice president of Northeast operations.

She said the idea for the track for observant Jewish women grew out of conversations she had with staffers at Relief Resources, a Brooklyn-based mental-health referral service that caters to religious Jews.

The therapeutic approach is not all that different from the general treatment program, or that of the other specialized tracks, Shore said. “What’s different is that you don’t have to spend time explaining what lashon hara” — the Jewish prohibition against gossip — “is, so it allows us to focus on the issues, rather than focus on the differences.”

Indeed, Nathanson, the social worker who struggles with bulimia, said frequent misunderstandings about her Orthodox lifestyle can leave her feeling out of place during group therapy sessions. “The other women will ask me why I don’t rebel,” she said. “Sometimes I think they think I’m from Mars.”

Judith Ruskay Rabinor, a Manhattan- and Long Island-based psychologist who is not affiliated with Renfrew, said that in addition to easing the group-therapy dynamic, the new track has the potential to unmask the ways in which “Jewish rituals can feed into the eating-disorder dynamic.” Rabinor, author of the 2002 book “A Starving Madness: Tales of Hunger, Hope and Healing in Psychotherapy” (Gruze Books), cited as examples fast days and binging on the Sabbath.

Hilary Yohlin, 27, who suffered from symptoms of anorexia for more than a decade before she was hospitalized briefly at Renfrew’s Philadelphia facility five years ago, said she wishes the track had been available when she was undergoing intensive treatment for her eating disorder. Yohlin, an observant Conservative Jew, said that while Renfrew taught her to replace disordered behaviors with much healthier behaviors, the program didn’t take into account issues regarding Jewish fast days and the social pressures surrounding holiday meals.

“I never learned how to integrate a healthy lifestyle with a Jewish lifestyle, so there was this huge gaping hole,” she said.

Jerusalem-based writer Ilana Kurshan, a contributor to the anthology “Going Hungry: Writers on Desire, Self-Denial, and Overcoming Anorexia” (Anchor, 2008), said that if there was such a track at the Long Island facility where she was hospitalized for anorexia about a decade ago, it might have been easier to keep kosher or observe the Sabbath. But she also wondered if being treated alongside so many other religious women would have made the problem worse.

“Anorexia is an extremely competitive disease — you don’t want to be thinner, you want to be the thinnest — and it’s easier to be competitive with people who are more like you,” she said.

Renfrew officials will discuss the new program at the June 7 eating-disorders conference. The event will feature keynote addresses by Altmann and by Rabbi Abraham Twerski, a psychiatrist who has written and spoken extensively about eating disorders, and about the communal pressures to be thin among young Orthodox women — especially those in search of a shidduch. Both Altmann and Twerski are featured in “Hungry to be Heard,” which will be screened at the conference.

The documentary was the brainchild of Elisheva Diamond, a doctoral candidate in clinical psychology and a member of the Orthodox Union’s Young Leadership Cabinet. “I wanted to create a film that is sensitive to the issues in the Orthodox community, and have community members take part in it,” she said. “Usually, people are looking to distance themselves from issues of mental health — and it’s much easier to do that when people suffering from them don’t look or seem like you.”

Diamond is also working with a colleague to adapt Harvard Medical School psychologist Catherine Steiner-Adair’s trans-denominational Jewish eating-disorder prevention curriculum for Orthodox yeshivas.

Diamond said that fostering communal awareness will protect more people from the anguish of eating disorders.

Nathanson, who has experienced that anguish first-hand, is hopeful that continued one-on-one and group therapy, alongside nutritional counseling, will help her ongoing recovery. She says she now looks forward to attending communal Sabbath dinners — without fear or shame.

“Those meals are such a part of Judaism, and I don’t resent that,” she said. “I just resent my eating disorder because it makes it so hard for me to be a part of that.”

Contact Gabrielle Birkner at [email protected].

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