ORIGINAL ARTICLE Do Medical Models of Mental Illness Relate to Increased or Decreased Stigmatization of Mental Illness Among Orthodox Jews? Steven Pirutinsky, BTS,* Daniel D. Rosen, MD,† Rachel Shapiro Safran, MA,‡ and David H. Rosmarin, MA§ Abstract: Research suggests that attributing mental illness to moral causes and perceiving it as dangerous relates to greater stigma, whereas belief in biomedical factors is associated with less. Within the family-centric Ortho- dox Jewish community, mental illness is perceived as a risk to family functioning and future generations, and is therefore stigmatizing of the individual and their family. Since biomedical models may exacerbate these concerns, we hypothesized that unlike within the general population, biolog- ical causal attributions would relate to increased stigma among Orthodox Jews. Consequently, we also examined the attitudinal correlates of stigma- tization of obsessive-compulsive disorder within the Orthodox community, as measured by both social distance and family/marriage concerns. Results indicated that, unlike previous research, biological models were associated with greater marriage/family stigma, and did not predict less social distance. This suggests that biomedical approaches may increase salient aspects of stigma within the Orthodox community, and clinical practice should be sensitive to these concerns. Key Words: Stigma, orthodox, jews, medical model, mental illness. (J Nerv Ment Dis 2010;198: 508 –512) I ndividuals with mental illness have a long history of facing stigmatization, which has several negative consequences such as social rejection, employment and housing discrimination, reduced self-esteem, and disinclination to pursue mental health services (United States Department of U.S. Department of Health and Hu- man Services, 1999). Current research (e.g., Corrigan et al., 2003; Link et al., 1999; Martin et al., 2000) suggests that perceptions of dangerousness and belief in moral causes of mental illness (e.g., the way the individual was raised, bad character) relate to increased stigmatization, whereas belief in medical causes (e.g., stress, genet- ic/biological causes) is associated with lower levels of discrimina- tion. Consequently, the National Alliance for the Mentally Ill, the National Institute of Mental Health, and the Mental Health Associ- ation, among others, have launched efforts to “medicalize” public conceptions of mental illness with the hope of reducing support for moral models that may be used to justify social discrimination. Although this has been a valuable strategy for fighting stigma among the general population (Corrigan and Penn, 1999), there is a danger in applying the same formula across cultures because culture, like many other aspects of mental illness, may influence the attitudes underlying stigmatization and its expression. Therefore, the current research examines the effect of medical models on the stigmatiza- tion of mental illness within a unique religious culture—Orthodox Judaism. Orthodox Judaism is premised on the divine origination of the Torah (Hebrew Bible) and its many commandments, and adherents apply these biblical precepts, interpreted extensively in the Talmud, to every facet of their lives (Schnall, 2006). These detailed religious laws including Sabbath observance, dietary restrictions (e.g., not mixing milk and meat), daily communal prayers, and prescriptions for family life, which help to infuse daily life with religious responsibilities and significance. In addition, Orthodox Judaism includes a comprehensive meaning system (Maimonides, 12th century/1990), focusing on belief in a monotheistic God, acceptance of his commandments, and eventual messianic redemption. Furthermore, many Orthodox Jews limit their contact with the secular world (Huppert et al., 2007) by forming cloistered communities centered on this religious ideology. However, Orthodox Judaism is a broad categorization within which exist numer- ous subgroups defined by dress, language, culture, and religious em- phasis. One key distinction is between the more religiously traditional and culturally isolated Ultra-Orthodox and the more moderate Modern Orthodox (Loewenthal and Rodgers, 2004), and both these groups were included in the current research. It has been widely noted that many Orthodox Jews fail to seek treatment for mental illness, whereas those who do, insist on placing a premium on secrecy (e.g., Lowenthal, 2006; Rosen et al., 2007; Witzum and Buchbinder, 2001). Previous reports attributed this to the strong family-centric value system operating within the Ortho- dox community (Loewenthal and Rogers, 2004; Margolese, 1998; Schnall, 2006). Of specific importance is the stigma among Ortho- dox Jews that often focuses on the perceived consequences of mental illness to family functioning, stability, and children. Conse- quently, the stigma of mental illness often extends to siblings and children of the individual, since they are perceived as being highly affected (Margolese, 1998; Schnall, 2006). These aspects of stigma can also negatively affect marriage prospects, as dating within the Orthodox community is often prearranged after an investigation of family and personal background by both sides (Rosen et al., 2007; Schnall, 2006; Witzum and Buchbinder, 2001). The resulting loss of social status may lead to avoidance of individuals with mental illness and their families (Witzum and Buchbinder, 2001; Rosen et al., 2007). Given these unique cultural factors, belief in medical causes of mental illness may exacerbate stigma among Orthodox Jews, as mental illness attributed to biological causes may be perceived as a threat to family functioning and children. Consequently, the current research endeavored to examine the attitudinal correlates of stigmatization of mental illness within the Orthodox Jewish community. Because stigma is a multidimensional construct measured in multiple ways (Link et al., 2004), we used both a traditional measure of stigma—social distancing of the individual with mental illness (Link et al., 2004)—as well as a measure of family/marriage concerns. In addition, we chose to focus on obsessive compulsive disorder (OCD) since previous research suggested that it is stigmatized, subject to a variety of causal *Department of Psychology, Georgian Court University, Lakewood, NJ; †Depart- ment of Psychiatry, Maimonides Medical Center & New York University School of Medicine, New York, NY; ‡Department of Professional Psy- chology and Family Therapy, Seton Hall University, South Orange, NJ; and §Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA. Send reprint requests to Steven Pirutinsky, BTS, 802 Twin Oaks Drive, Lake- wood, NJ 08701. E-mail: stevenpirutinsky@gmail.com. Copyright © 2010 by Lippincott Williams & Wilkins ISSN: 0022-3018/10/19807-0508 DOI: 10.1097/NMD.0b013e3181e07d99 The Journal of Nervous and Mental Disease • Volume 198, Number 7, July 2010 508 | www.jonmd.com