Social phobia in ultra-orthodox Jewish males: culture-bound syndrome or virtue?

Social difficulties of the performing variety are reported by ultra-orthodox male referrals to a psychiatrist in Jerusalem and confirmed by key communal informants. Three cases of social phobia are presented, and the content concerns performing, either speaking on religious matters publicly, a role associated with status and authority, or leading prayers and ceremonies, a role of sanctity and duty. The absence of women sufferers may be understood as a consequence of the value placed on modesty in women and there being no expectation of women to participate in study and public prayer, while the absence of complaints of interactional social phobia may be a consequence of the general discouragement of social intercourse not related to religious study. Aymat zibur, literally meaning fear of the community, is a term used by ultra-orthodox Jews to describe these fears of performance, although in its original meaning the term expresses the respect that the leader of prayers is expected to have for his awesome role. The cases described, however, were motivated by personal shame, similar to social phobia of the performance variety found in other cultures, rather than fear and respect. The values of ultra-orthodox religious life are presented that invest a person who avoids interactional social behaviors with the status of zaddik (a righteous person) while one who avoids the performance behaviors of speaking publicly on religious matters or leading prayers suffers from an idiom of distress in this particular society. Religious law and societal mores appear to be critical factors in deciding whether symptoms of social phobia are perceived and experienced as idioms of distress.     

Special perspective: An immodest proposal: should treating mental health professionals be barred from testifying about their patients?

Notwithstanding ethical rules that address therapeutic and forensic role conflicts for psychologists and psychiatrists, overzealous patient advocacy by therapists, tightened reimbursement for therapy, and a growth market for forensic psychology and psychiatry, have led many therapists to appear willingly as forensic experts on behalf of their patients. Existing ethical rules, as well as other proposed approaches to address this problem, assume that it can be resolved by modest changes in existing practice that permit therapists to testify as long as their testimony avoids psycholegal opinions. This essay questions whether these modest changes can adequately address this problem and advances consideration of a more radical proposal to address this problem, prohibiting therapists from testifying about their patients. © 1998 John Wiley & Sons, Ltd.