Question: My sister has a difficult time with her 2 of her children. They are socially awkward, struggle in school and seem to me to be very anxious. Whenever they go through something difficult, she seems to quickly find a "medical" related reason why whatever is happening is happening. One time it's strep, one time PANDAS, or Lyme disease or whatever else. She runs around from doctor to doctor getting all sorts of treatments for them.  None of the treatments are familiar to me as "standard". She does not "believe" in therapy or psychiatric medications. I understand that these things I mentioned are real illnesses, but I wonder how common they really are and why they seem so much more common in our community. I think she is overlooking the standard options for something more exotic. I don't know that mine or anyone else's opinion will make a difference to her but am hoping the panel could provide some education as to some of these rarer diseases that seem to me to have become very popular in our community. Why are things that are supposedly rare seemingly common in the community? What are some guidelines that parents, and educators can use to see if someone is pursuing a correct path for psychological diagnosis or are going down a long windy road that ends up nowhere good?

This is an important and relevant question. While some social/emotional presentations may have medical causes, too often we see the pattern that you describe; there is a pursuit of an explanation that is not traditional nor based on the research evidence. In my work with child behavioral challenges, I often find a "flavor of the month" feel for these challenges. This can be a pursuit of nontraditional medical explanations, alternative therapies, or modalities that are not research-based. The common denominator with all is that they are alternative and, as of now, unproven treatments. It is indeed possible that some of them may prove to be helpful and even more effective than standard medicine. It is also possible that some of these treatments are ineffective and benign and, finally, it is possible that some may be harmful. This tendency is more common when it comes to mental health, and is less common among medical conditions, such as cancer. We have a body of evidence suggesting that procedures such as radiation and chemotherapy are effective. Alternative medicine may recommend acupuncture, minerals, and biofeedback, yet the overwhelming majority understand that these recommendations stand in the background and are not first-line. 

 I would like to share a few thoughts about this phenomenon that address the following questions:  a) what is evidence-based treatment? b) why, in our communities, is it more common to seek alternative treatments? and c) What can be done about this?

Evidence based treatment is about treating people with the best knowledge that the mainstream profession has to offer. This means that the professional thoroughly understands the diagnosis as well as the specific personality variables and life situation of the individual and, based on that, recommends the best available treatment. This recommendation is based on the huge research and clinical literature that is currently available. Alternative medicine, by definition, means that it is not accepted as first line treatment due to insufficient or negative evidence of its effectiveness. Alternative medicine may still be an option for a) those who specifically prefer this and b) as a second line treatment when all else fails but should not be the starting point.

Why would people turn to alternative treatments? 1) The most likely reason is that the recommended mental health route (such as medication or specific types of therapy) is associated with increased stigma. This is an unfortunate reality, especially in our communities, that hopefully can be changed with time. 2) There are also religious and cultural factors that may play into this. From a religious perspective, we cultivate a healthy skepticism with regard to ostensible scientific findings (e.g., religious restrictions during COVID, metzitza b'pe). This can (incorrectly) carry over to those scientific areas that do not touch on halacha or hashkafa. From a cultural perspective, we are (purposely) more insular and therefore less exposed to sources of medical information. We therefore tend to rely more on word-of-mouth information. In addition, we are more close-knit and tend to share information and interact more with others as opposed to other communities that obtain advice from medical professionals. From my perspective, the degree of community insularity is directly related to the prevalence of the above factors.

Because this phenomenon is more common in our communities, it is probably best addressed on a broader level. Rabbinic and organizational leadership should understand these stigma and other cultural factors and continue to recommend following standard medical advice. When people hear information from trustworthy sources, they are more likely to accept.