BETWEEN SACRED AND MEDICAL REALITIES - CULTURALLY SENSITIVE THERAPY WITH JEWISH ULTRA-ORTHODOX PATIENTS

One disconcerting aspect of the role of culture in shaping human suffe ring is the gap between the explanatory models of therapists and patie nts in multicultural settings. This gap is particularly noted in worki ng with Jewish ultra-Orthodox psychiatric patients whose idioms of dis tress are often derived from a sacred reality not easily reconcilable with psychomedical reality. To meet the challenge to therapeutic effic acy that this incompatibility may pose, we propose a culturally sensit ive therapy based on strategic principles that focus on the patient's mythic world and religious idioms of distress as the kernel of therape utic interventions. Using one case of post-traumatic stress disorder ( PTSD) as illustration, we seek to show how the religious symbols throu gh which the patient's distress was articulated may be manipulated to effect cure. The case highlights the narrative quality of both illness construction and self-reconstruction.