Paper for the Jewish-Orthodox Christian dialogue group, Faculty of Divinity, Cambridge University, 18th May 2023.
What can Judaism contribute to discussions about mental health?
1. MADNESS
Since the birth of literature, madness has featured in stories. ‘The Greek heroes go mad; some are driven wild with frenzy; others become beside themselves with fury, revenge or grief.. Homer’s heroes are .. at the mercy of forces essentially from Beyond and beyond their control: gods, demons, the fates, the furies.’[1]
In the Hebrew Bible, in Daniel chapter 4, King Nebuchadnezzar has a disturbing dream of a tall and flourishing tree reaching to heaven; an ‘ir v’kaddish’ (‘a watcher and a holy one’) then descends from heaven and instructs him to cut down the tree and just leave a stump. Daniel interprets the dream for the King; the King he himself is the tree and he will be driven from humanity and eat grass like an ox for a period of time described as ‘seven fixed times’ — either seasons or years. This duly happens, and he lives like an animal, his hair and nails unkempt, and eats grass, until eventually his manda, his ‘knowledge’ is restored. Magical Mesopotamian texts suggest that such an illness could have a divine source,[2] and that seems to be the clear implication of the way the story is told. The commentators Rashi and Ibn Ezra glossed the ‘watcher and holy one’ as an angel. The King certainly descends into some kind of lower world where he is estranged from God. It is likely that the Aramaic term manda is the origin of the name of the Gnostic faith known as Mandaean.
In second temple literature outside the bible, such as Jubilees, the origin of ‘impurity’ (tumah) was connected to people descended from the mating of the angels (shomrim) to the daughters of men (the Nephilim of Genesis 6:4, as commented on in Jubilees 7:21)[3]. In the Talmud, the skin disease tzaraat is attributed to a ruach, a spirit (Ketubot 61b).
In the Mishnah we come across a disease called bulmus, a word derived from Greek to which the modern term ‘bulemia’ corresponds. ‘If someone is seized with a manic hunger (bulmus), they may feed him even unclean foods until his eyes light up.’[4] The implication here is that his eyes have become dim because of the illness. His eyes brighten at the moment of recovery, just as King Nebuchadnezzar lifted up his eyes to heaven when his time of despair was up.[5] That symptom of dim eyes, and the use of the term ‘seized’ (as if the bulemia, like Nebuchadnezzar’s illness, has come from outside), suggests that this is some kind of mental seizure from an unknown, perhaps spiritual source. The mishnah goes on to discuss the treatment for someone bitten by a mad dog, which would also have been considered to be ‘possessed’ in some way.
The Talmud contains a rich literature on demons and the threat they pose to humans.[6] For example, in the part of the Talmud which deals with the Passover seder, there is a discussion of the idea that it was dangerous to set out on a journey after drinking an even number of cups of wine (an odd number is safe). There is much discussion about the details, and which number of cups was better or worse. ‘Rav Pappa said: Yosef the Demon said to me: If one drinks two cups, we demons kill him; if he drinks four, we do not kill him.’[7] Sara Ronis argues that ‘the Babylonian rabbis neutralize demons by turning them into subjects, informants, and teachers of rabbinic law, thus subjugating them to the legal system.’[8] Like an acute mental illness, drunkenness can disrupt human reasoning. However, the link to mental illness is just one of many different ways demons function in Talmudic discourse. The clearest link I have found between demonic possession and acute mental disturbance is not from a Jewish source, but from the Christian scriptures, where a man with in an unclean spirit can even break the chains which bound him, and wandered in the mountains and in the tombs, shrieking and cutting himself with stones.[9]
There were, and are, many different ways of understanding what mental illness is. In ancient times much less distinction was made between the categories of physical illness, mental illness, physical injury and psychological damage than we make today. Alongside this, the spiritual world and the physical world were imagined to be much closer than we think of them today. So possession by demons was one way of explaining illness and injury of all kinds. It was much more holistic than most medicine today. Indeed, the simplest answer to our question ‘what can Judaism contribute to discussions about mental health today’, is to say that Judaism (and indeed any approach which draws on ancient sources) can contribute a holistic approach.
Ideas of illness being caused by angels, spirits and demons sat alongside quite different notions of illness. Hippocrates of Kos (c 460 – 370 BCE) was credited with inventing the theory of the ‘four humours’, but it is through the physician Galen (129 – 216 CE) and his successors that the idea persisted right up until the growth of modern medicine. The ‘humours’ are different fluids within the body; blood — in excess it could make you ‘sanguine’, yellow bile, which could make you ‘choleric’ black bile which could make you ‘melancholy’ and phlegm which could make you ‘phlegmatic’. Through the humours, your physical health was intimately connected with your character and your mood. This too was a holistic approach.
The Jewish legal category of the shoteh is important for understanding attitudes to mental health and illness. Along with the katan (the child) and the cheresh (the deaf-mute) the shoteh was considered exempt through incapacity from following the commandments. It is not clear whether the term designates somebody with poor mental capacity or somebody mentally ill. Probably, no clear distinction was made between the two. The question is asked in the Talmud: ‘Who is a shoteh?’[10] and three examples of how to recognise the category are given: someone who goes out alone at night, someone who spends the night in a cemetery, and someone who tears their clothes. The Israeli psychiatrist Rael Strous suggests that the shoteh is suffering from a psychotic illness or perhaps schizophrenia. Three categories were designated — somebody who is a shoteh all the time, somebody who cycles in and out, and somebody only temporarily affected. Whilst in the psychotic state, or whatever it was, the shoteh is unable to make clear decisions. Thus, for example, they may be exempt from paying legal damages or contributing tithes (taxes), or engaging in business negotiations, and be entitled to the practical assistance of the community. The court can step in and support his family, if the shoteh is a man. If it’s a woman, she cannot be divorced, however much her husband wants to get rid of her.[11] The Talmud itself offers a comment on wandering around at night alone: ‘And one who goes out alone at night, I would say that the gandripas seized him.’ And Rashi comments: I have heard this explanation: a sick person gripped by worry. But it seems to me that he is physically hot and goes out into an airy place.[12] A modern commentary on the word gandripas states: He has been seized by a sickness that comes from worry (lycanthropy, a form of melancholy, in which the sufferer believes himself to be a wolf (or dog) and spends his nights among tombstones); OR he has become feverish (and is going outside to cool off).
A more recent Jewish notion sometimes attributes disturbing behaviour to possession by a dybbuk. This word, which means ‘cleaving’, is first found in the sixteenth century, and denotes a disembodied human spirit which ‘cleaves’ or attaches to a living person and speaks through them. Solomon Ansky’s Yiddish Drama Der Dybbuk (1906) and Joseph’s Steins screenplay for Fiddler on the Roof have both made the concept very well known in our time. The miracle working rabbis who expelled the talking Dybbuk do not seem so different from Jesus expelling demons in Mark and other Gospel texts.
2. DEPRESSION AND ANXIETY
Depression is attributed to a spirit (ruach) in the Bible, as we see in the story of King Saul: ‘But the spirit of the Eternal God departed from Saul, and an evil spirit (ruach ra’ah) from God troubled him.’[13]
Saul’s servants try to explain to him what is happening, telling him that an evil spirit from God is terrifying you. They suggest finding a lyre player to soothe him, and the young David comes along to play for him, and as he played, King Saul found relief, and the narrator tells us that the evil spirit departed from him.
The ‘evil spirit’ can also be found in this passage of the Mishnah: ‘If someone puts out the Shabbat lamp from fear of gentiles or robbers or an evil spirit, or to allow someone sick to sleep, he is exempt.’ [14]
On this Maimonides writes in his Mishnah commentary: ‘“An evil spirit.” This is kind of illness called in Arabic malconia, because there is a type of that illness such that the patient flees and separates himself from people, when he sees light, or when he is in the company of others.. and his psyche rests in darkness and loneliness, and he is desolate.’[15]
Notice how Maimonides, as a skilful physician and philosopher, is able to combine our two ancient strands of thinking, when discussing a depressive illness – some kind of disturbance of the psyche, from God or something else in the spiritual realm – with the physical excess of black bile, melancholy (which is what the word means). In another part of his Mishnah commentary he wrote:
One who suffers from melancholia may rid himself of it by listening to singing and all kinds of instrumental music, by strolling through beautiful gardens and splendid buildings, by gazing upon beautiful shapes, and other things that enliven the mind, and dissipate gloomy moods. The purpose of all this is to restore the healthful condition of the body, but the real object in maintaining the body in good health is to acquire wisdom.[16]
Before the advent of modern drugs, that must have been a very useful prescription.
3. MENTAL WELL BEING
It is worth our while lingering with Maimonides a little longer, because he managed in his writings to combine his thoughts about treatment with notions of mental health in its true sense of being more than an absence of mental disorders, but a state of well being. He writes about this both in his medical writings and in his Hilchot Deot in his law-code Mishneh Torah.
Maimonides complete code of Jewish law, Mishneh Torah, was written in Hebrew in the 1170s. The initial section ‘The Foundation of the Torah’ deals with belief in God, and the third section with the commandments about study of Torah. But in between the two comes a section often ignored today, about cultivating good physical and mental health. It is entitled ‘Hilchot Deot’ ‘Deot’ is a difficult word to translate; in modern Hebrew it mean ‘opinions, views’ but in Maimonides title it is translated as ‘discernment’ or ‘human dispositions’. The root simply means ‘knowing, knowledge’, the same root as used for Nebuchadnezzar when his ‘knowledge’ is restored to him. Under this heading Maimonides first lists the command ‘to imitate God’s ways’, and this is the headline which enables him to offer a discourse about how to stay healthy. He begins with a description of the effect of the ‘humours’ which lead to our different temperaments, and then clearly states ‘The right way is the middle path’ which means neither to be too hot tempered nor without feeling, but in between, not to eat more than necessary, not to work too hard or too little, nor to spend nor give away too much or too little; in short we should ‘be glad all our days in moderation and receive everyone with a friendly countenance, for men of equanimity are called wise.’
His ’Regimen of Health’ (Fī Tadbīr Aṣṣiḥḥa) was written in Arabic in 1198 for the Egyptian Sultan Afdal Nur al-Din Ali who was suffering from depression. Maimonides advocated a training in philosophy:
As for people who are trained in moral philosophy or with religious ethics and sermons they gain courage for themselves so that their souls are disturbed as little as possible, whether they are in a state of blessing or a state of curse. If one acquired great good from the world, what the philosophers call ‘the imaginary good’, he is not afflicted by it, and the good things do not become overly important to him: similarly, the bad things are those that the philosophers call ‘the imaginary blows of fate’: he does not despair and he is not anxious but bears this things with beautiful patience.[17]
Although today we may find Maimonides’ descriptions very medieval, the idea of specifically cultivating mental health and well being is vital. Other writers within the Jewish tradition known as musar (‘discipline’) took this up. The foundation text of modern Musar is a short book called Mesillat Yesharim “The Path of the Just” by the Italian rabbi Moses Chayim Luzzato (1707 – 1746) known as the Ramchal. Luzzato used the Hebrew word midah ‘trait’ to mean an ethical value worthy of our attention and study. Out of Luzzato’s foundation text, Rabbi Israel Salanter (1809 – 1883) founded the musar movement, turning text into practice. Today’s practitioners of modern musar meditation, a kind of Jewish mindfulness, are using their time to cultivate both their mental well being and their devotion to Jewish ethical values.
Take a map of Ukraine, find Kyiv, Lviv and Odesa and then find the centre of the triangle. Somewhere near that point is the small town of Bratzlav once home to the famous Chasidic tzaddik/master Rabbi Nachman of Bratzlav (1772 – 1810). He didn’t live in Bratzlav for long – he lived a wandering life, both in body and in mind, a life well documented by his disciples and more recently in English by Arthur Green in his book Tormented Master (1979). Nachman suffered from anxiety depression and loneliness his whole life, and this motivated much of what he did. In 1798-9 he undertook a very perilous journey to Eretz Yisrael/The Holy Land. Green argues that he was far more motivated by the great dangers of the journey than in what who he would meet and what he would see there. Later in life he became a prolific teller of stories, and one of his most famous, which exists in several versions, is the story of a prince who went mad and thought he was a turkey. He would sit naked under the dining table to gobble up scraps of food. A wise man volunteered to help. He stripped off his clothes and joined him under the table, saying he was a turkey too. Gradually he persuaded the prince that turkeys could wear clothes, and then that they could cope with human food, and even sit at a table. He carried on until he had cured him completely.
I think this story represents a modern approach to mental well-being, an approach in which therapy plays a huge role. The turkey-cure seems to anticipate CBT, cognitive behaviour therapy, a method of helping which encourages changes of behaviour rather than psychological change. Perhaps Nachman of Bratzlav found similar approaches of use to him in his own troubled life.
Nachman devoted much of his time to counselling and helping other disturbed people, anticipating in some ways the role of a communal rabbi today. In our time, it is common for people with emotional problems to turn to a religious leader or pastor for help. Practitioners in multi-faith chaplaincy teams and religious communities are trained to see the good in every person, to treat people as unique individuals. Jewish chaplains and pastors have in their tool-kit uplifting psalms and readings, reflections and prayers. Much more use could be made of Maimonides’ holistic approach and of musar practice.
Too often, rabbis and Jewish care workers in Britain today are unable to give sufficient attention to cultivating mental well being because they spend their time ‘firefighting’ — dealing with too many emergencies. Until the seriously mental ill are properly looked after, cultivating well being and preventative intervention cannot be properly prioritized. The exhausted rabbi who has been up all night with a member of the congregation waiting for an ambulance which hasn’t come may is likely to be unimpressed that the emergency services prioritise those who have had a stroke or heart attack over someone who has taken an overdose but is still fully conscious. Until we can get the National Health Service back on its feet again, discussions like the one we are having today may seem purely academic. It shouldn’t be like that.
A final thought from Torah. ‘I am the Eternal God who heals you’[18] This verse from the book of Exodus has a huge variety of interpretations, including comments by early Karaite Jews who took it to mean that human physicians should not be consulted. But the nineteenth century R. Meir Leib by Yehiel Michael (Malbim) explained that the Torah and commandments that God commanded Israel were not given in the manner of a master giving instructions to his servant, but rather in the manner of a physician giving instructions to his patient. If a physician instructs his patient, it is for the patient’s sake, not the physician’s. Similarly, God’s commands are for our benefit ‘to heal our sick souls.’[19] Through our spiritual searchings, we can alleviate our mental distress.
© Rabbi Dr Michael Hilton, 2023
[1] Roy Porter, A Social History of Madness: Stories of the Insane, (Weidenfeld and Nicolson London, 1987), 10-11
[2] Hector Avalos, ‘Nebuchadnezzar’s Affliction: New Mesopotamian Parallels for Daniel 4’, Journal of Biblical Literature, 133.3 (2014), 497-507.
[3] In Jubilees 10:1 they are referred to as ‘polluted angels.’ See also I Enoch 15:8 – 12 (‘evil spirits’); 11 Qumran Psalms Scroll A 19:16 (‘unclean spirit’): Qumran War Scroll 13:5 (‘Satan’ and ‘the spirits of his company’)
[4] Mishnah Yoma 8:6.
[5] Daniel 4:34
[6] Sara Ronis, Demons in the Details: Demonic Discourse and Rabbinic Culture in Late Antique Babylonia (University of California Press, 2022).
[7] Babylonian Talmud Pesachim 110a
[8] Sara A. Ronis, Thesis Abstract ‘Do Not Go Out Alone at Night: Law and Demonic Discourse in the Babylonian Talmud’ Sara A. Ronis 2015 (https://www.proquest.com/openview/9d705064c9cb108b97147e1c749f3f19/1?pq-origsite=gscholar&cbl=18750)
[9] Mark 5:2-5.
[10] Babylonian Talmud Chagigah 3b.
[11] Rael Strous, ‘Halakhic Sensitivity To The Psychotic Individual: The Shoteh’
Assai, 4:1, February 2001 (http://www.daat.ac.il/DAAT/kitveyet/assia_english/strous-1.htm)
[12] Babylonian Talmud Chagigah 3b.
[13] 1 Samuel 16:14
[14] Mishnah Shabbat 2:5
[15] Maimonides Commentary on Mishnah Shabbat 2:5.
[16] Maimonides Introduction to Mishah Avot (‘Sayings of the Fathers’), Chapter 5. This translation is adapted from Joseph I. Gorfinkle, The Eight Chapters of Maimonides on Ethics (Shemonah Perakim): A Psychological and Ethical Treatise (Columbia University Press, New York 1912), 70. The phrase literally translated here as ‘beautiful shapes’ is sometimes rendered as ‘beautiful pictures’ and sometimes as ‘beautiful women.’ (Samuel Ibn Tibbon: chevrat hatsurot hayafot, https://babel.hathitrust.org/cgi/pt?id=uc1.a0001178367&view=1up&seq=87)
[17] Gerrit Bos, Maimonides On the Regimen of Health: A New Parallel Arabic-English Translation (Brill Leiden 2019) 107, using my own translation.
[18] Exodus 15:26
[19] Malbim, commentary on Exodus 15:26; Fred Rosner, Medicine in the Bible and the Talmud: Selections from Classical Jewish Sources (Ktav New York 1977) 103.