Hess E. Forbidding the Permitted, Permitting the Forbidden-on Drives and Prohibitions in Psychotherapy in The Ultra-Orthodox Religious Community

Esther Hess, PhD

Review Article

Ann Depress Anxiety. 2024; 11(1): 1124.

Forbidding the Permitted, Permitting the Forbidden-on Drives and Prohibitions in Psychotherapy in The Ultra-Orthodox Religious Community

Esther Hess, PhD^1,2*

¹Psychotherapist in Private Practice, Bnei Brak, Israel

²Supervisor, Maayanei Hayeshua Medical Center, Bnei Brak, Israel

Corresponding author: Esther Hess, PhD Psychotherapist in Private Practice, & Supervisor, Maayanei Hayeshua Medical Center, 14 Elisha St. Bnei Brak, 5152302, Israel. Email: hesses.office@gmail.com

Received: September 18, 2024 Accepted: October 08, 2024 Published: October 15, 2024

Abstract

The ultra-orthodox (Haredi) Jewish community in Israel adheres to strict observance of religious commandments with regard to separation between the sexes, and demands maximum personal modesty and discretion in all areas related to sexuality. Consequently, many young people find themselves facing a difficult conflict between their natural urges or drives and the restrictions imposed by the religious law (Halacha). In this article, I open a window onto this subject in the hope that the wider therapeutic community will attain a deeper understanding of the suffering and the complex emotional struggles experienced by these young people.

I begin with a short theoretical overview of sexuality and a brief review of the literature. I then present several case studies which illustrate different aspects of the complexities faced by patients in this community, followed by a discussion.

Keywords: Sexuality; Drives; Prohibition; Forbidden; Permitted; Sublimation; Halacha; Orthodox; Religious

Introduction

To realize a dream, it's necessary to forget it,

to divert our attention from it. To realize is thus to not realize.

Life is full of paradoxes, as roses are of thorns.

Fernando Pessoa: Writing about sexuality within the ultra-orthodox (Haredi) Jewish community in Israel means touching that which is most sacred and most precious, a highly sensitive subject normally discussed only in professional and rabbinical counseling sessions, and in private. The laws of intimate life in the religious Jewish tradition are preserved within a bubble isolated from the outside world, a community where people’s lives are ruled by the Halacha -- the laws and commandments of ancient Judaism. In such a setting, the boundaries between the forbidden and the permitted are clear and unyielding.

In this article, I will present some questions and thoughts arising from my clinical work. Is it possible to alleviate mental suffering within a whirlwind of emotions and pangs of conscience, and if so, how? Is it possible to find a balance between drives and wishes on the one hand, and prohibitions and beliefs on the other?

As a psychotherapist who is herself a committed member of the Haredi community, I present this writing as a testimony, the opening of a door which I hope will lead to clarification and understanding. To be a witness means being the door itself, turning both inwards and outwards [36].

The world has changed since Freud's day. His teachings on unfulfilled drives and on neurosis brought on by conflict sound archaic now, covered in layers of dust. Psychological knowledge and research are constantly evolving, and in today’s world, sexuality covers a wide range of gender-related issues and is discussed freely and openly. Within the Haredi community, however, we find ourselves in a different, more basic and primal space, an enclave that is largely protected from exposure to pornography and other explicit sexual materials. Instead, we find a kind of “primal innocence” -- a place where Freud’s words still sound young, fresh, and pertinent.

Stories From an Ultra-Orthodox Clinic -- Two Vignettes

Ruthie

Ruthie is a typical 16-year-old ultra-orthodox girl who attends a religious school for girls only. Dressed very simply and conservatively, as required by her school, in a skirt that covers her knees and a loose, long-sleeved blouse, she has been talking for the last thirty minutes about what her friends are wearing, which group each one belongs to, what types of clothes are prohibited or permitted, and related issues of modesty and acceptable behavior. We have been discussing this topic for several months now, as if the nuances of the school uniform are what hold the earth in place and ensure its movement. Ruthie is indeed dressed very simply, but she has chosen her clothes with care and her outfit shows the first signs of a legitimate aspiration for something different, more contemporary, even within the restrictions of modest dress. In the Haredi community we see that teenage girls express their rebelliousness, their need to stand out as individuals and perhaps even their need to cross disturbing and suffocating boundaries primarily through their preoccupation with clothing, since other options such as recreation or contact with members of the opposite sex are not available to them.

Moti

[Note: A yeshiva -- an orthodox Jewish school for boys only, where the entire curriculum is devoted to Torah studies]

Moti, a nineteen-year-old yeshiva student, sits frozen in the armchair, his gaze downcast. He moves his legs from side to side uncomfortably, and hesitantly tells me that once again he has felt a strong attraction to a friend younger than himself during the lesson, and this unsettled him because he was unable to concentrate on his studies. "I don't know what's happening to me. When I look at him and his smooth face, it arouses me." Moti is wrapped in grief and guilt, he is blushing, and it is evident that he is working hard to overcome his feelings of shame. Since boys studying in a yeshiva are not permitted to have any contact with members of the opposite sex, he has no way to express his heart’s desires and drives except through fantasy. Moti is afraid that his feelings for this younger boy, who has the face of a young girl, indicates some kind of homo-erotic attraction. Frightened, he seeks therapy, and within the protected therapeutic space he slowly allows himself to reveal his innermost feelings and even his wildest fantasies. Gradually he develops a greater understanding and sense of legitimacy, and he manages to retain his sense of being attracted to women and to wait for the right time when he will meet girls for the purpose of marriage. These two vignettes provide a glimpse into the inner worlds of adolescents in a conservative, ultra-orthodox community. The openness and free communication that are taken for granted in the secular world are almost entirely absent in a society where conservative lifestyles are maintained, and where principles such as modesty for women, the prohibition of sexual relations before marriage, and gender separation in educational frameworks and in everyday life are strictly enforced from a very early age.

Modesty and Intimacy in the Ultra-Orthodox World

When the Almighty created woman, He pondered from where to create her. He did not create her from the head - lest she be lightheaded. Nor from the eye - lest she be curious. Nor from the ear - lest she be a gossip. Nor from the mouth - lest she be talkative. Nor from the heart – lest she be jealous. In the end, He decided to create her from the rib, a hidden and modest place in the body, and as she was being created, He entreated her: "Be modest, be modest" (Midrash, Genesis Rabbah 18:3).

Within the Haredi community there is a continuous process of adaptation to the modern world, alongside -- and sometimes in conflict with -- the upholding of the older conservative ways. Nevertheless, the requirement of modesty for girls and women remains one of the key principles of the Haredi way of life, and the need for modesty, in appearance, in speech, and in everyday behavior is deeply ingrained in the being of a religious girl.

The world of girls and women with their obligation to modesty runs parallel to the world of boys and men, whose struggles are even more difficult because of the prohibition against having sexual relations before marriage and because the institution of marriage is so central and significant in Jewish culture.

First, the most serious prohibition, inducing fear in every young boy and man, is the prohibition against ejaculating semen or “spilling his seed” in vain (Babylonian Talmud, Niddah 13b). This prohibition is intended to ensure that the primary purpose of the semen is preserved, and that the response to sexual urges and the commandment “to be fruitful and multiply” take place only within the framework of marriage. Furthermore, ejaculating semen in vain, that is, for a purpose other than reproduction, such as masturbation, is similar to killing the fetus that could have resulted from sexual intercourse (Babylonian Talmud [BT]: Niddah, 13a).

The Sages recognized the immense power of the sexual drives, and established frameworks designed to distance the individual from transgressions and to increase man’s control over these drives [30]. The war against these drives is a challenging battle because “Man's evil desire gathers strength against him daily” (BT, Kiddushin 30b). And yet, it is not impossible. A person is capable of becoming the “master of his desire” by confronting it head-on, and by dedicating himself to the study of Torah and adhering strictly to the prohibitions [30].

This issue is well known in the Haredi educational settings and yeshivas. Rabbi Shlomo Wolbe, referring to young men who are not yet married, writes that "Yet almost all youth stumble with this and are unable to find the strength to overcome this in any way" [35]. His words show a clear awareness of their difficulties and their near-impossible attempts to cope.

Clearly, in such a setting any boy with a conscience who succumbs to the urge to masturbate will be consumed by guilt. These difficult feelings trouble him and interfere with his daily functioning. In this context, Rabbi Munk [24] writes that in his position as an educator, he presents himself as an example and tells his students about himself and his failures in the prohibition against speaking ill of others [lashon ha-ra - literally, “the evil tongue”]. He compares the prohibition of ejaculating semen in vain to the prohibition against lashon ha-ra, in order to help the boys transform and reduce the fears which stem from an aggressive and dominating super-ego.

We know that every human being, religiously observant or not, is subject throughout his life to a constant conflict between self-control and surrendering to his drives. A moral and conscientious person will know how to conquer his urges when necessary. Regarding conquering urges according to the Halacha, the Sages added, "the human urge only desires that which is forbidden" (JT: Nedarim 9a), meaning that it is precisely the prohibition that increases the urge, the longing, and the need to fulfil this longing. Indeed, “forbidden fruit is sweeter”. Here the power of the human ego stands between the pressures of the drives (the libido) on the one hand, and moral obligations on the other; this is the role of the human ethos, of the innermost knowledge of what is and is not acceptable or appropriate in society, what is proper and what the soul cannot tolerate. When the world of commandments and prohibitions, including the knowledge and thought of sin, of punishment, of reward and compensation for every deed, is clear and unambiguous, internalized, and within the scope of the superego, we see that orthodox individuals find themselves in a state of ongoing and intense conflict in their daily life, a conflict that continues until the day of death [30].

On Sexuality in General - from Freud Onwards

Freud [8] Hebrew edition 2021), who was the first to conceptualize the drive theory, viewed drives as biological needs accompanied by a longing for fulfillment and satisfaction; when the drive is not satisfied, a negative state of tension is created. This tension accumulates as “conserved energy” that can be channeled in various directions.

Here I will relate to the sex drive, an internal, innate, physiological stimulus that is triggered by an external factor such as a sight, fantasy, or thought. The drive seeks to achieve satisfaction; dissatisfaction causes frustration. Freud believes that unrealized drives are at the root of neurosis and underlie various mental disorders [8].

In “Beyond the Pleasure Principle”, Freud [10] describes the arousal in the psyche which he defines as "the most obscure and inaccessible region of the mind" [10]. He attempts to explain the relationship between the drive for pleasure and the absence of pleasure (“unpleasure”), and adds that the absence of pleasure intensifies the excitation in the mind, while the achieving of pleasure reduces it. This thinking helps to understand how prohibitions can actually intensify the drive for pleasure.

Freud's successors viewed dealing with drives not only as emotional coping but as part of the individual's development within the environment, and also as part of object relations. To review in brief:

Sullivan [33] did not see needs and drives as something problematic or animal but rather as very human phenomena, aimed at enabling interactions with others. It is the anxiety accompanying these feelings and thoughts that sabotages and disturbs. He further clarified that a baby learns about the nature of his actions and about being 'good' or 'bad' through the reactions of the caring figure - the mother. When a baby touches his/her genitals, the mother may show a reaction of dissatisfaction. This is how babies learn the moral standard of each situation, and they even develop anxiety about an unpleasant reaction, which creates a sense of “I am bad.” This may explain the feeling of aversion and distancing from subjects related to sexuality, starting from early childhood experiences and through to adulthood. Winnicott [34] vividly describes the infant's dependence on the care of a “good enough” mother. A very central stage in the development of the baby and the child is the creation of an integration of the personality, which is a natural flow between the id and the ego. “In health the id becomes gathered into the service of the ego, and the ego masters the id, so that id-satisfactions become ego-strengtheners” [34]. He adds there “that when such achievements are not reached or only minimally, the id remains relatively or totally ‘external’ to the ego, and id-satisfactions remain physical, and have the effect of threatening the ego structure” (ibid).

Fairbairn [6] questioned Freud's premise that the fundamental motive in life is pleasure and proposed his own view that the libido is 'object-seeking'; he emphasized the search for a benevolent object, as distinct from the search for pleasure. He saw the search for an object not for the purpose of release and reduction of tension by the other, but rather for the connection with the other as an end in itself [22].

In a similar vein, Kohut [16] regarded the sexual drive as a human search for a necessary sense of existence. In sexual pressures and intense aggression, which Freud defined as basic human drives, Kohut saw disintegrating parts of the self-striving for a sense of wholeness and existence out of an empty inner world. He viewed the sexual drive as a quest for existential stability.

In contrast to Kohut, Kernberg’s (1980) conception is faithful to Freud; he adds the context of the development of the self through object relations to the Freudian concept, and sees sexuality as a derivative of deep and primary structures of internalized object relations and of the integration between powerful passions of love and hate.

Mitchell [23] believes that sexuality is a powerful biological force, a force that necessarily appears in a relational context. The arousal of the physiological response, the experience of the response, and the form in which it is etched in memory are all shaped by the interpersonal context.

Thus, in this short review we have seen a transition from an intra-psychic understanding of the sex drive to a view of the individual as needing a benevolent, calming and stabilizing object, and this as a response to calming the drive and filling the void that prompts the arousal of the drive.

It seems that Freud's theory fits perfectly with the two vignettes presented in the opening section. As we know, the threat presented by the drives is related to the Halachic imperatives and the laws of the Torah. Between the desire for pleasure and an attempt to curb this desire, there is a constraint which is a kind of defense and avoidance of pleasure, a kind of conflict between the life drive and the death drive [10]. Thus, if we understand the effect of object relations, we can observe the individual who is torn between the drive and the prohibition, and understand that the rabbis and other authority figures who mediate God and the laws of the Halacha to the students are perceived as objects similar to their parents, and who exert a similar level of authority.

Sometimes the rabbis or teachers may over-emphasize the prohibitions and commandments and add stern warnings or threatening stories; this may explain the heightened levels of anxiety we see in the clinic. Moreover, there is also an object relation with G-d, on whom we project our relationship with our parents, as a heavenly, all-powerful object, from whom we expect a kind, parental type of understanding and giving.

Thus, various authority figures (parents, rabbis, teachers) who reinforce these prohibitions may be perceived as benevolent objects, or alternatively as forbidding, warning or threatening figures. Within the ego there is a fear of confusion between love, hate, and longing for relationships with the other, all of which require integration within the self.

How to Deal with the Sex/Pleasure Drive

Sublimation is the most mature defense mechanism, and one form of this mechanism is the expression of the sexualurge in the form of domineering and aggressive behavior. Freud writes that there is aggression in sexuality and when the sexual side cannot be expressed, the aggressive part emerges [8].

However, the sublimation mechanism may also prove beneficial by redirecting the impulse to artistic and creative pursuits. The libidinal energy seeks an outlet, and in the absence of a sexual outlet, the ego tries to sublimate or engage in other activities, and thus works to keep itself alive [8].

Laplanche and Pontalis [18], following Freud, say that sublimation manifests itself in engaging in artistic activity and intellectual exploration, adding that these activities are not directly related to sexuality, but that the actual engine behind them is the sexual drive.

At a later stage, the neo-Freudians and object relations theorists disagreed with Freud, preferring to see culture as the development of more autonomous and spiritual forces of the ego.

Gay [13] writes that Freud's words are thought-provoking, and the obvious question is how exactly the mind harnesses instinctual energy resources in the service of cultural pursuits. Elsewhere, in response to Freud, Gay [13] suggests that there may be a transformation from drives to creativity, but this process does not lead to the transformation of a drive. He adds that Freud did not take into account the negative results of deflecting the drive and repressing it in this way.

Lewald [19] discussed Freud's conception of sublimation, which deals with the connection between drive theory and culture and art. According to him, culture is not only an instinctual derivative, but a product of rational values and personal disposition. Lewald sees art as a combination of experiences, fantasies, feelings, and images that help in symbolizing and representing everyday reality.

Later, Abel-Hirsch [1] explained that Bion saw sublimation differently than Freud. For Freud, sublimation, as a defense mechanism, involves converting these primal energies into more acceptable and constructive forms of expression, such as creative pursuits, intellectual endeavors, and artistic expression.

Bion, however, regards this defense mechanism as ineffective because it suppresses the sex drive. Instead, he sees sublimation as an uplifting and enriching occupation, a yearning for something sublime such as art or religion, and not a restraint that encourages repression to the point of malignancy.

Rotenberg [31], who combines the ideas of Judaism and psychology in his writings, uses the term “channeling” instead of “sublimation” while distinguishing between sexual-physical and spiritual powers. He suggests that sexual frustration may act as a stimulus for spiritual achievements and believes that sexuality has the power to regulate or coordinate both physical and spiritual forces. In a view that sees a union of body-mind, Rotenberg suggests a connection between the Hebrew noun yetzer, [physical desire], and the related noun yetzirah, [spiritual creativity]. The inability to attain sexual satisfaction actually becomes a desirable state, which opens the door to spiritual creativity.

In view of this understanding, Rotenberg concludes that the sexual drive is desirable, but that men are called upon to direct it to the study of Torah, a spiritual occupation, and that the spiritual satisfaction thus created positions the libido in a less central place in life rather than the primary focus. To quote from the Babylonian Talmud: "If this villain (evil urge) beset you, pull it to the house of study" (BT: Sukkah, 52b; Kiddushin, 13b).

Of course, there are young men who do not gain sufficient satisfaction from the study of Torah, and thus do not reach a higher level of sublimation. These boys may engage in various activities within the yeshiva, such as charity and community work, musical activities, organizing social events or teaching younger boys. They may also release their libido by smoking, making cynical jokes, or other light-hearted activities.

In some cases, we will see acts of protest and rebellion, attempts to escape from a complex confrontation, and the use of avoidance as a defense. These are often the individuals who eventually leave the ultra-Orthodox environment and abandon the orthodox way of life.

Permitted or Forbidden?

Patients such as Ruthie and Moti, presented earlier, illustrate viable, tolerable forms and fairly routine forms of coping within the Haredi community. Ruthie observes the requirements for modest dress but also longs to free herself from these restrictions and to dress in a more fashionable, modern way. Moti is frightened by his confusion about his sexual identity and his attraction to younger boys in a society where he has no opportunity to meet girls. They turn to therapy because they are suffering from symptoms such as distress, sadness, loneliness and social withdrawal.

My next case study, Hanan, deals with the question of what is permitted, or how to permit the forbidden.

Hanan

A tall, handsome, and outstanding yeshiva student, Hanan loves to study and is very diligent. He tells of a happy childhood as the youngest son in a family with three older sisters. Hanan came to therapy because of persistent, disturbing thoughts about punishment and the threat of Hell. These thoughts have been haunting him for about two years and accompany him every hour of his day. He is very depressed and talks little; his speech is concrete and laconic, logical and sharp, without any affect. Hanan believes his thoughts, which he calls “the annoyance”, and he is looking for a quick and practical solution. He is convinced and convincing that his strong commitment to in faith and study is real, good, and correct, and that he has reached a high level of Torah studies. This illusion sustains him and helps him deny the other feelings that pulsate behind his disturbing thoughts.

When I asked what helps him deal with "the annoyance", he describes two ways to obtain relief: he likes to smoke, even describing himself as a heavy smoker, and he also likes to go to friends' weddings, because vodka is available there. It seems that drinking alcohol affords him great relief. When I asked how he learned about alcohol, he replied that he tried it for the first time at a Purim party. Hanan is aware of the danger of addiction and tries to reassure me, and perhaps himself, by saying that vodka is expensive, and he only drinks it when there is an opportunity, such as at a wedding, where it is served sparingly. He admits that with the cigarettes he has already 'fallen'.

I try to talk about hidden wishes and desires, even those that may be difficult to think about and that could lower his sense of self-esteem if he were to allow himself to become aware of them. Hanan listens and continues to tell me about the liberating experience of smoking.

I interpret for him the release of the 'smoke' as steam being vented and say that it would be good to release many more emotions like 'smoke'. It is difficult for him to connect with the emotional aspects; he listens as if I am speaking a foreign language.

At the beginning of therapy, Hanan asked for permission to smoke inside the clinic and was refused. I explained about the rules of the therapeutic setting, and he complied with them with noticeable reluctance. After a while he tried to persuade me to allow him to slip in an electronic cigarette, arguing that "it doesn't bother anyone." We talked about crossing boundaries, about an impossible law that provokes a desire to rebel against it. Hanan responded with a smile and admitted that he had a need to cross boundaries.

At the next session, Hanan arrived with a bag of sunflower seeds, and said: "I brought them for us to crack.” I smiled, although I felt uncomfortable because this was not appropriate to the therapeutic setting. I commented that it seemed that he wanted to make the session a pleasant social event. Hanan smiled, pulled the bag towards him, and started cracking the seeds open. The sunflower seeds were our “guests” during several sessions where I often interpreted the “cracking” between us as a means of diversion, in order not to talk too much, to avoid understanding or going deeper, as a buffer separating us, a transitional object. In fact, the Hebrew verb le-fatze’ah crack, used to describe the act of cracking open objects such as nuts or seeds, is the same verb used for ‘cracking’ ( solving or deciphering ) a mystery or code. We also talked about using one’s mouth to crack open the seeds as a means of releasing energy, perhaps as a way of dealing with other energies that are more difficult to acknowledge and release. Hanan agreed with me, but this did not stop him cracking nuts during the session.

One day Hanan brought a dream to the session, and warned me that his dream was very confused. I should add that no seeds were cracked during that session.

It takes place on Purim because in the dream I'm looking for vodka. I go to all kinds of places and stores and can't find vodka. I see that everything is closed, and I'm very frustrated and think I'll miss Purim without vodka. Two charming girls bring a drink to my friend. He is far away from me and so are they. I watch out of the corner of my eye and I’m jealous... because of the vodka, or the fact that girls came to him... Later I wait for the bus and it doesn't come. I have to walk, I don't know exactly were. I walk into the store and ask for sunflower seeds, but I can't pay because Shabbat has already started. I suggest to them that I crack seeds there, in the place... Somehow my grandmother is there and I feel her love.

When I asked him what thoughts came to him after the dream and during the telling, he replied that he was very confused, and that he understood that things that preoccupied him came back in the dream, such as girls, vodka, cracking seeds...

He did not understand what his grandmother was doing there. I ask what significant emotion he felt during the dreaming. He thinks for a moment and replies: Pressure, not succeeding. I add: Frustration, nothing is attainable... Hanan listens, surprised by the fact that the dream represents a series of frustrations, of not being able to realize what he wants. Everything in the dream fails, he adds, but at the end, comfort appears in the shape of his grandmother.

Unable to open up and articulate his locked inner world, Hanan searches for activities that bring him immediate gratification. Drinking vodka and cracking seeds are “sublimation” activities. The material that Hanan brings deals with concrete expression, with a sign and not with symbolic use. The cracking, for example, is an enactment of unconscious motives; it holds hope for Hanan, and he unconsciously feels that it is possible to 'crack', that the continuous act of cracking will bear fruit and lead to a deeper understanding. Indeed, the cracking helps him to get to the ambivalent dream that brings him to self-knowledge, to the cracking open of the conflict between desires and prohibitions.

The dream takes place in an open place, where there are many temptations that Hanan is exposed to, but these are not accessible and some are even forbidden. Hanan was forced to walk, to hold the parts of his self on his own. He arrives at a store where there may be an option to 'crack' what is happening to him, but then the law comes into force - Shabbat is coming and "it is impossible to pay". At this point the frustrating conflict between the desire and the prohibition is realized. Later, comfort appears in the figure of the grandmother, known to us in the therapeutic context as a containing and benevolent figure. Because Hanan has no option for a physical release of his desire, another hidden need, perhaps more real, emerges - the need for love, which is the thing in itself, the unconscious wish, concealed in sensory satisfactions. This is a need that is difficult for Hanan to talk about and perhaps he is not even conscious of it, but he feels it in the atmosphere of the treatment room and in the transference process.

If we look at the dream as representing an 'inner theater', we see the dialectic between two aspects of the self: Hanan's attempts to obtain vodka, nuts and girls represent the longing, living, and instinctual self, while the grandmother represents a comforting and calming self.

We discussed this dream in several sessions. The analysis of the dream represented the attempt to understand what was happening to Hanan and to crack (decipher) it. The dream work led to a transformation, from talking 'about' things and translating them into sensory action, to knowing the inner speech and understanding the conflicts. Hanan gradually gained the ability to understand himself beyond the facts. Since that time, he has stopped cracking seeds in the clinic.

My thoughts after the dream, and as I was writing, connected me to the words of McDougall [20], which describe the diffusion of uncontained feelings through actions. McDougall claims that sometimes, out of an aspiration for the unity of body and soul, and lacking the ability to be aware of and distinguish an overwhelming and disturbing emotion, release is achieved by acting out as a defense against emotional pain; such were the cracking of seeds, the drinking of vodka, and the smoking.

It is possible that Hanan never learned to understand himself out of a 'misidentification' [26] because no one helped him to touch the emotion and recognize it. Also, perhaps Hanan is dealing with a 'second skin' [4]. He 'wraps' himself in smoke, his mouth is busy with repeated cracking. These actions are for him a kind of 'second skin', a substitute and defense for what was not there, for the missing wrapping and the connection that he longs for.

Bion (1962) also helps to understand the case and refine it. He believes that failure to process beta-elements, which have not been symbolized and processed, are experienced as noumena or 'things-in-themselves'. With Hanan we saw in concrete expressions that with the development of the process and through the dream, beta-elements were processed and transformed into alpha-elements in a soft and non-threatening way.

Forbidden!!! And how do you cope?

Nadav

Nadav, a young man in his twenties, left his yeshiva because he felt that the studies were causing him general aches and pains, which made walking and functioning difficult. It is hard for him to understand and explain these pains, and he is disturbed by the fact that they prevent him from studying, since he claims that the study of Torah is his heart’s desire and also the wish of his parents. Medical tests revealed no clinical problems, but one doctor suggested that the pains might be stress-related, and so he was referred for treatment. Nadav feels sad and dejected, cannot “find himself”, and does not believe that he can be helped.

Nadav tells me that he comes from an essentially religious, Torah-centered and demanding home. He is an only child, born to his parents after years of waiting and they have very high expectations of him. Nadav feels that in order to gain their respect and love he has to study, excel and be a masmid (one who studies Torah constantly, with great diligence).

In high school, he started out as an excellent student, but gradually, thoughts about his sexual identity began to preoccupy him. He explains that the confusion started when he felt an attraction to friends in a younger class, and at the same time - an attraction to his female cousins and other young women whom he encountered.

In our meetings, Nadav takes pain to declare again and again that he is 'gay' -- almost as if he is trying to persuade himself and me of this. It occurred to me that this could be an unfamiliar side of him, a hidden, formerly unrecognized sexual urge that arises parallel to the regular urges [2]. However, his repeated declarations raised doubts in my mind. Nadav, for his part, tells me again that 'he needs to act' and that there is “no room for emotions”. The persistent message he received at home and at school was: move forward, take action, study and succeed.

This “no-room-for-emotions” statement actually caused me some unexplained tensions prior to my session with him, as I certainly sensed some feelings “in the air” [3]. I realized that it was difficult and frightening for Nadav to relate to emotions of affection, closeness and perhaps also erotic feelings.

In the first period of the treatment, it seemed that there was no way out. Everything was seemingly 'fine' but Nadav is suffering; he is in pain and very sad. He observes the commandments scrupulously as he was raised to do, but he became very frightened once he experienced the natural and characteristic drives of adolescence. In one of our sessions, when he complained of pain and emphasized his sexual orientation once again, I reflected to him that it seemed he felt obligated to tell himself and me. After repeating several statements of this kind and hearing my interpretations, Nadav confessed that he is actually attracted to women. He added that he takes pains to declare that he is gay in order to convince both himself and me that there is no danger that he will fall or stumble, God forbid, into doing something that is forbidden. This is precisely due to the strong attraction he feels towards women.

We talked about wishes and natural drives, fantasy versus reality, and Nadav's lack of trust in himself and his abilities to overcome and cope. I reassured him that we are in a therapeutic situation and that his feelings towards me are normative and part of the projection of other characters onto me. Later, Nadav was emboldened to speak frankly and tell me that he feared that I would be critical of him. He tearfully related that his mother stands guard to check and make sure that he does not deviate from the right path. She also asks about his sexual tendencies and even intrudes on him in his own room. During the transference process, Nadav projected his fear of an authoritarian and aggressive mother while at the same time admitting that he was attracted to me as a woman.

As our relationship deepened and Nadav acquired more trust, he found the courage to relate that he did masturbate but that he strenuously denied this to himself out of fear. He rationalized what was happening by saying that these were normal secretions as a result of his exertions. After these revelations and connecting to his feelings more honestly and openly, his complaints about pains decreased and his walking also appeared to improve.

Later, Nadav shared with me his thoughts and reflections about what happens to him while studying. During these hours, he begins imagining urges and drives, and he encourages and 'invites' them. This is exactly the moment when his pains reappear. Although he understands that this is most inappropriate, it happens precisely while he is engaged with spiritual things, along the lines of ‘forbidden fruit is sweetest’. In fact, he enjoys reflecting on his drives and fantasizing that he can fulfil them. After Nadav's insight, we could clearly see the connection between the studying, the thoughts, the drives, and the strange pains.

The treatment process is exhausting. Every time we talked a little more 'openly', Nadav resisted. He was startled that I dared to call things by their name and face them openly. Nadav clings tightly to his symptoms, and believes that if he succeeds in studying even harder, he will achieve a ‘cure’. We talked about options for sublimation, but it is difficult for Nadav to see himself engaged in sports or any energy-releasing activity. Introspection is foreign to him, and he battles to see his personal suffering beyond the prohibitions and conventions. This complicated situation became clearer to me in light of Kernberg's (2009) writings about the libido and the death drive, where an unconscious conflict is created between instinctive sexual drive and aggression. The sexual drive strives towards satisfaction and happiness or, alternatively, towards destructive aggression towards the self or towards the other. Nadav could not reach fulfillment, satisfaction, and happiness. His aggressive impulses were directed inwards and were causing him pain and suffering. At the same time, he clung to the existing situation out of fear of giving up his studies.

As his distress continued, however, he began to reach a deeper understanding of his suffering and his need to resist “letting go” of his symptoms.

Can this Really be Permitted?

Hani

A common phenomenon among ultra-Orthodox women is excessive meticulousness in the laws of family purity, to the point of a truly obsessive-compulsive tendency. Greenberg and Witstum [14] give an extensive and detailed description of forms of Obsessive-Compulsive Disorder (OCD) related to family purity laws (pp. 117-120).

Hani is a married woman in her thirties, and the mother of five children. Hani reports great difficulty with everything related to intimate life during the years of their marriage because of her problem around the night of the mikvah [ the monthly ritual bath]. She tells me that all other areas of her life are conducted smoothly and with good communication with her husband.

When Hani has to immerse in the mikvah, she becomes very pressured. The very act of immersion causes her fear, repugnance, great tension, discomfort, and the hope that it will be over quickly. Clearly the immersion, which serves as a transition from impurity to purity, causes her periods of great stress, due to her awareness of the meaning and power of this ritual and the responsibility she has for the preparations and implementation. Therefore, this event may lead to anxiety and obsessive repetition as a defense mechanism.

A deeper understanding reveals that Hani is somewhat stressed about the immersion ritual but more so about what follows. The transition is difficult for her, as she told me:

How is it possible that one moment everything is forbidden; he (her husband) can’t even hand me anything. And after a short time, everything turns upside down. How can it be?? Is it the action of the water?? What's going on here??

I can't believe it. It can't be that suddenly everything is permitted! I am confused, I can't believe it and am unable to give myself.

Hani cannot digest what is 'permitted', what is possible, what is 'okay' and right. If the Halacha is so strict, it is hard to process this sharp transition. We talk about the difficulty of accepting the good, of containing something that one deserves. Of course, we also examined other aspects of her marriage. Hani is convinced that her relationship with her husband is good and that she is not depressed at all. She explains to me that the Halacha is so threatening that it is difficult to remove the sense of threat so easily... Who decided that it is, okay??

Hani is torn between two positions: first, the prohibition and the need to comply and second, a position of enjoyment and giving oneself over to it. It appears that she was stuck in a ‘schizo-paranoid’ type of conflict, trapped between the severe and uncompromising prohibition on the one hand and a softer, gentler ability to reach a transformation both within herself and in her external reality on the other. The therapy helped her to soften and link these two positions and to reach a depressive-integrative state where she could move away from the prohibition and at the same time make room for permitted emotions, drives and pleasure.

In this case, there is also the withholding of pleasure and causing sorrow, behavior that has a masochistic effect, or as Freud [9] said, behavior that avoids satisfaction for as long as possible, a kind of blocking of the life drive. From another aspect, masochism may also be caused by the need to overcome one's drives, since the ability to control oneself causes satisfaction. Elsewhere Freud writes about feminine and moral masochism that manifests itself in the need for punishment, and about a sense of guilt originating from the super-ego [11]. It is also possible that this masochism is directed at the object in an indirect way; by denying herself the possibility of pleasure, she also hurts her partner through her own personal suffering.

How mysterious is the psyche and how it protects itself in creative ways! When encountering pain in the therapy room, we can only try to be there, present and attentive, to understand and contain, as Rosenheim (1990) says, "because the pain of the soul longs for an echo that resonates with great emotional intensity, because the pain will otherwise go unheard. As a Jew prays to God on Yom Kippur: ‘Store our tears in your flask.’ Just as the tear wants to be gathered in, so, too, our remaining voices seek to be rescued from their loneliness and to find a warm embracing corner for themselves" (p. 54).

Discussion

I opened the article with the role of the Halacha in understanding human drives and in the struggles of patients as observed within the ultra-Orthodox religious community. The writers reviewed in the section “On sexuality” above do not relate to the specific difficulties encountered by patients in this community. We know that conflicts are an integral part of our very existence, certainly the intense conflicts of adolescence. However, it appears that without a deep familiarity with this world of religious observance, it is difficult – if not impossible – to understand the delicate balance between the force of the prohibitions and commandments, the power of a supportive community and an appreciation of the subtle nuances of the social conventions and lifestyles. Only through a continuing awareness of the interplay between these issues will the therapist be able to achieve the necessary dimensions of tolerance and acceptance of the other with true empathy and understanding.

We can identify three main types of conflict in our patients:

A concrete encounter with the conflict: Every adolescent boy and girl in the community goes through normative maturation processes. Faced with their wishes or drives, they encounter a prohibition, feel uneasiness, and hopefully find a sympathetic adult with whom they can share their difficulties. This situation can be seen as neurotic normative behavior.

Ruthi and Moti illustrate this situation

Suppressed and hidden conflict: The power of the Halacha is great and mighty. It evokes the dread of judgment, the fear of committing a sin, and the expected punishment. The enormous power of the fear of punishment apparently leaves no room for lenience and compromise. Consequently, patients may find themselves in a “no way out” situation, which leads to their emotional deterioration.

Parallel to the fear of the punishment is involvement with the prohibition and thoughts about it. This preoccupation intensifies the drive and desire to such an extent that the emotional hunger causes extreme distress. And as Freud [10] explained, the more that unpleasure exists, the stronger the need and drive for pleasure. Denying pleasure is the result of Halachic observance, and this drive has no outlet. Many times the way to deal with that emotional hunger is to ignore and deny it, and sometimes things go so far as to be transformed into either action or a state of depression. In the case of Hanan, there is a denial of the urges, a search for other satisfactions while simultaneously ignoring the pain and frustration, until reaching a situation of reaction formation.

Somatization -- diverting the conflict to the body: Nadav and Hani illustrate this type of reaction. When difficult emotions such as silenced rage, anxiety, and distress are not acknowledged or processed mentally, they undergo somatization and are directed to the body in the form of physical pain. As McDougall [21] explains, the psyche uses the body in order to transmit a message. When the emotional pain becomes unbearable and cannot be contained, the pain is transferred to the body and the patient develops psychosomatic symptoms.

In Nadav's case, it seems that he was unable to access his turbulent emotions and consequently he experienced intense pain. Hani is unable to experience physical pleasure as a result of unresolved conflicts.

The drive and with it, the prohibition: We will never be able to reconcile them, or perhaps only in so far as there are other worlds, cultural and spiritual, where a person may occupy themselves and achieve satisfaction, creativity and even fame. All of these do not eradicate the drive but stand beside it, providing a kind of enabling and balance, adding a significant dimension to life while allowing the drive to continue to exist.

When an unfulfilled instinct or drive torments a person, the creative imagination can play a decisive role. It fills in and describes to the individual their heart's desire and the fantasy involved in fulfilling it; this is in contrast to an animal, which is incapable of self-restraint and satisfies its appetites immediately. A person's abilities, skills, and the richness of their imagination attest to their capacity for creativity [12].

This idea connects to the concept of 'yetzer-yetzira ['desire-creation'] as discussed by Rotenberg [31], who believes that it is wrong to repress the urge but rather that one should channel it into creative action. A midrashic proverb says: " No one leaves this world with even half his desires fulfilled" (Midrash Kohelet Rabbah 1:13), that is to say that a person's desires are never fully realized. Herein lies the benefit, because when an individual's desires are not gratified, he energizes other forces residing within the self.

This Jewish view that sees value in the non-fulfillment of wishes is prevalent also in other religions. Kornfield (2008) describes the Buddhist concept thus: "Desire casts a spell on us and we pay the price; when we are lost in desire, our heart closes." And in the same spirit of Buddhism, he adds that desire causes suffering, and it arises in situations of loneliness, boredom, or emptiness. "The lonelier and more desperate we feel, the more we tend to turn to our desires as a source of compensation" (pp. 206-205).

The confusing and complex interrelationships between fantasy and reality are described by Eigen [5] in one concise sentence: "Life's penchant for nourishing fantasy is greater than fantasy as nourishing life" (p. 64).

I will end with Pessoa's words from the opening, which focus and summarize the insights with surprising simplicity: "To realize a dream, it's necessary to forget it, to divert our attention from it. To realize is thus to not realize."

Author Statements

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, E.H., upon reasonable request.