Psychology and Biblical Studies

 

SBL Annual Meeting Papers, November 2010

For review only; do not distribute

 pdf version

 

Medicine and Judaism: Physical and Psychological Concepts

Ilona Rashkow, New York University

Popular folklore has it that the watchword of every Jewish mother is, “Ess, ess meine kind” (“Eat, eat my child”), or the modern-day alternative, “Try it, you’ll like it.” Despite these favorite mottos, traditional advice from the Jewish sages was far more concerned with matters of health than is ordinarily assumed. Jewish dietary laws are not health laws, but religious laws addressing the spirit rather than the body, even though many of them do contribute to the prevention of illness.

For example, there has been an enormous growth in the popularity of manufactured kosher products even among non-Jews, driven, in part, by an increasing interest in healthier foods. However, keeping kosher is not necessarily equated with healthy living. Both eating to excess and eating high cholesterol foods are unhealthy – regardless of whether or not they are kosher. 

Similarly, some have suggested that many of the provisions in the Book of Leviticus are a model for later practice. For example, the provisions relating to what is described as leprosy are not dissimilar from twenty-first century communicable disease legislation. The traditional view is that these various requirements, while they may have been appropriate from a public health standpoint,  are concerned with matters of “purity” of the body and “spirituality.”  And of course, the leprosy referred to may not have been what is now referred to as Hansen’s disease.

The same could be said for brit milah (ritual circumcision). Despite all the controversy that arises from time to time as to the value of circumcision in disease prevention, Jews perform it for purely religious reasons – “clip” or “be clipped from the tribe” – but that topic is appropriate for an entirely different section!

Quite apart from all the mandated practices outlined in the Torah, the Rabbis who wrote the Talmud, Mishnah, and Midrashic writings were concerned also about health matters that do not have religious overtones – both physical and psychological.  Today I would like to discuss some of the physical and psychological concepts of health in a very few of these texts.

While it is true that the Talmud does not contain medical treatises except in the context of religious practice, much of what the sages said is still relevant. For example, it advises physicians that a thorough examination of the patient is necessary for a correct diagnosis. Notably, courts continue to hear medical malpractice suits where this has not been done.

Judaism’s concern for the preservation of health is quite clear.  However, it is also clear that neither the biblical writers nor the Talmudic writers could possibly have considered the provision of health care the same way as in today’s world (despite the fact that there are over one hundred and thirty references to “health” in the Talmud). Although a straightforward application of biblical and Talmudic material to the modern health scene might be viewed as somewhat anachronistic by other than Orthodox Jews, Jewish views on the importance of health and on the distribution of scarce resources do add a dimension to current issues relating to health and religion – both physical and  psychological. 

The preservation of  well-being is looked upon in Judaism as a religious command. “Live through them, but not die through them” is the principle applied to all the laws of the Bible, from which the Rabbis deduced that in case of danger to life all laws except those against idolatry, adultery, and murder might be violated. The neglect of one’s health is regarded as a sin. The Nazarite who vowed to abstain from wine was considered a sinner, as well as he who fasted or underwent other penance without reason.  “Purity,” which is the aim of most of the Biblical sanitary laws, was to be not only physical, but also moral and religious.  Since there was no a distinct department of public health in the government of the ancient Jews, the charge of infectious diseases, such as leprosy, and of epidemics of all kinds, was delegated to the Kohanim, who acted as the physicians;  in addition, the Talmud mentions the “office” of a physician in the Temple whose duty it was to look after the health of all the Kohanim – the doctors’ doctor!  Later, every town counted among its permanent officials a physician who supervised circumcisions and looked after the communal well-being.  Significantly, scholars were forbidden to live in a city where there was no physician (are there any members of the SBL to whom this prohibition might apply?).

The Bible regarded health and disease as coming from the same divine source: “See, then, that I, I am He; There is no god beside Me.  I deal death and give life; I wounded and I will heal: None can deliver from My hand” (Deut 32:39).  As a result, they who ministered to the health of others were regarded as the messengers of God, as the executors of His will. Although the Hebrew Bible deity is the physician of Israel (“If you will heed the LORD your God diligently, doing what is upright in His sight, giving ear to His commandments and keeping all His laws, then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I the LORD am your healer"  [Exod 15: 26]), the practice of medicine is sanctioned by the Law. 

The medical knowledge of the Talmudists was based upon tradition, observation of diseases, experiments upon animals, and surprisingly, the dissection of human bodies.  In the majority of cases, the art of healing was transmitted from father to son. The numerous medical aphorisms preserved in Talmudic and Midrashic writings, and the fact that physicians took part in the discussion of many important religious questions by the Rabbis, indicate that the Rabbis were not unacquainted with the science of medicine. That the demand upon the skill of physicians was considerable is indicated by the statute prohibiting the owner of a house from renting to a physician because of the noise and disturbance caused by the visiting patients!  The sum total of medical knowledge possessed by the ancient Hebrews cannot be stated definitely since neither the Bible nor the Talmud contains medical treatises as such.  The Mishnah mentions a medical book, “Sefer Refu’ot” (which was attributed to King Solomon and expurgated by King Hezekiah), and the Talmud cites a treatise on pharmacology, “Megillat Sammanin” but neither of these has been preserved.  Although medicine was an integral part of the religion of the Jews, medical subjects are alluded to only in so far as they concern or elucidate some point of law.

Now:  on to psychology.  It has been said that Freud’s greatest contribution to psychology was his Oedipal conflict.  Indeed, its central role in psychoanalysis is unquestioned. It comprises the third stage in Freud’s view of psychosexual development and is critical to explaining how the individual identifies with his or her same sex parent and how the superego is formed.  Yet over the past forty years, the question has emerged as to what the implications might have been had Freud substituted a narrative from the Hebrew Bible for this Greek story. 

One question which leaps out immediately is why this alternative approach did not occur to Freud himself, who after all was a Jew, even if in his own terms he was a “Godless Jew.”  In other words why was Freud drawn to the Greek legend of Oedipus rather than Biblical alternatives as the basis of psychoanalytic theory?  Why are the master stories of psychoanalysis borrowed from Greek mythology rather than from Hebrew Bible narratives? Certainly, the relationships of virtually every male and his son and/or father in the text could have filled a Freudian paradigm.  Freud’s choice seems odd even on programmatic grounds because the biblical tradition was better known to the general public than the Greek and could further more effectively the cause of psychoanalysis. 

Since the connection between psychology and traditional Jewish texts and narratives has been developed over a long period so this is going to be a very abbreviated examination.  A more detailed version of this paper is available is as a chapter in Professor H.  Harold Ellens’s multivolume series The Healing Power of Spirituality: How Faith Helps Humans Thrive (which, I understand, is now available).

Although psychology is relatively new as a formal academic discipline, for many years scholars have pondered the questions that psychologists ask and probably shall continue to do so for many more. Nowhere is this better exemplified than in the many centuries during which Jewish physicians and thinkers dealt with the problems of behavior and behavioral disorders. Many current theories of psychological disorders, classification, and therapy were foreshadowed in biblical and Talmudic literature, and Jewish philosophers wrestled with the same psychological concepts that still occupy attention today.

The Jewish art of healing always emphasized mental as well as physical health. Behavior disorders were well known to the early Hebrews, who were noteworthy for their observance of the laws of preventive medicine and hygiene. From the beginning, Jewish monotheism excluded all kinds of magic practices, considering them “disorders”  and opposed occult healing as “Amorite customs.”  The Hebrew Bible prescribed and the use of medicine (Ex 21:19; I Kings 17:21; II Kings 4:32–35; Ezek 30:21) and the prayer to “God your healer”  (Ex 15:26) for all mental and physical ills (would that it were that easy today!)

A few of the many cases of mental disorder described in the Bible include King Saul’s paranoia, depression, and epileptic seizures (treated by music therapy) and various types of insanity are cited in the Pentateuch, such as phobia and panic (Lev 26:17).

While the Talmudic description of shoteh (“the mentally insane”) approaches the set of symptoms of several psychoses, other psychological conditions mentioned are: hysteria, phobias, and melancholia.  Defense mechanisms such as repression, sublimation, and projection, and the concept of catharsis predate Freud in that they are cited in both the Bible (Proverbs 12:25 “An anxious heart weighs a man down, but a kind word cheers him up”) and in the Talmud.

Long before Freud, dreams were important within Jewish texts and among Jewish thinkers.  In antiquity, from Joseph to Daniel, and later among the Essenes, Jews were famous as “dream interpreters.”   The Talmud considers the dream “a sixtieth part of prophecy” which contains both relevant and irrelevant material, which “if not interpreted is like a letter not opened” (was Freud a secret Talmudic scholar?)  Halakhic literature deals with dreams related to oaths and promises, and with anxiety over a “bad dream,”  for which one is permitted to fast a ta’anit alom – even on the Sabbath or a holiday.

The nature and function of the soul, reason, and intellect were treated by Jewish philosophers in a seemingly psychological way.  Within traditional Judaism, the soul and the body comprise the total personality in the divine image and do not represent an essential duality. Although the biblical terms ru’a, nefesh, and neshamah are used synonymously, the rabbis identified the neshamah as the higher spiritual substance – what we  might call the human psyche.  In recognizing the conflict between the yezer ha’ra (the orgiastic drive to sin) and the yezer ha’tov (the positive inclination to control it), Judaism believes in the principle of free choice – a person can master the forces of the destructive yezer ha’ra, producing in Freudian terms a healthy ego.

Skipping ahead several centuries, among the many medieval Jewish philosophers who wrote on psychology, Isaac b. Solomon Israeli wrote Sefer ha-Yesodot (“The Book of Elements”) in which he discusses the interaction of mind and body and identifies melancholia as an emotional disorder and Jewish ideas about psychological illness have been attributed to Ḥibat Allah ibn Jumay (c. 1180), who was the physician to Saladin.  However, the most celebrated Jewish genius in this field is the famous physician of body and mind, Moses Maimonides, the most modern in approach of all medieval physicians.

Maimonides attributed to the soul five different faculties: the nutritive, the sensitive, the imaginative, the emotional, and the rational, the last being the distinctive, discriminating trait of humankind enabling the creation of ideas (Guide 1:70).  He advocated research through experiment and emphasized the high regard a physician should have for the human mind, and stressing a psychosomatic approach in therapy (Regimen Sanitatis, 3:13). He also differentiated between constitutional and environmental sources of behavior, urging the mentally sick to avail themselves of a “physician of the mind” (Code, 1:2) (I wonder if these “physicians of the mind” charged the equivalent of today’s customary $200 an hour?).  Seemingly anti-psychopharmacological, Maimonides warned against excessive use of tranquilizers to effect any radical changes in behavior (Shemonah Perakim, 1).

Quite modern from the psychotherapeutic point of view, he also insisted on complete psychological harmony between couples during sexual union  – for the benefit of the couple as well as their offspring, and viewed “physical health as a prerequisite to mental health and excellence.”  In his treatise on the manic-depressive state Maimonides proposed “a strict hygiene of the soul” based on mental calm.

Responsa literature also deals with mental diseases, strangely enough, in connection with wives’ matrimonial suits asking for a get (a Jewish bill of divorce)!  Among the topics discussed were: melancholia, hysteria, “lunacy,” manic-depressive states, megalomania, and character disorders.   As an example, Isaac Lampronti of Ferrara permitted the desecration of the Sabbath and holidays “to prevent a state of emotional anxiety” (Resp. Naalat Shivah, 83) in order to “please one’s wife”.   Music therapy, already used by King Saul and later treated separately by both Saadiah Gaon and Maimonides, was discussed also by Azulai in the Responsum Hayyim Sha’al, while hypnotism was noted by R. Jacob Ettlinger (d. 1871) in Binyan iyyon (67).   These scholars would probably felt quite at home at this conference!

Jewish religious law requires strict consideration and good care for the mentally deficient (Sh. Ar., YD 240:10; Sh. Ar., EH 119:6) and requires communal care for the insane, who “are not held responsible for their actions” (Sh. Ar., ḤM 924:8). Suggestive therapy “to pacify a patient’s mind”  is recommended by Maimonides and Joseph ben Caro on psychological grounds (Sh. Ar., YD 179:6) (perhaps they were the first behavioral psychotherapists).

Embedded in Judaism is a tradition of spirituality; a vision of well-being that is grounded in a fierce engagement with life; the importance of community, and a belief that sacred texts and rituals can be relevant to our modern psychological dilemmas in that both are simultaneously intensely private experiences yet inextricably bound to the community.

Within Judaism, concepts of health and illness – physical and psychological – originated in the Hebrew Bible, were elaborated upon by later religious texts, and involved more than just views about life and death.   How does Judaism approach illness and wellness? Are they separate and distinct aspects of life? Or, as the tradition seems to imply, are they two aspects of life’s total experience?

The word “spirituality” is sometimes associated with “New Age,” but Judaism has always recognized the importance of care of the soul/mind connection and its interactions with the care of the body. Jewish healing – physical and psychological – draws on a deeply rooted wisdom that has evolved for over 3500 years with a great deal to say about the effects of stress, isolation, and loss or injury of the body, mind and spirit.

The history and practice of Judaism is as evolving as the history and practice of psychology.  The approaches to mental health in ancient, Talmudic, and medieval Jewish texts seem to presage and anachronistically integrate modern psychology, medical science, complementary medicine and pertinent insights of other religious traditions.

I have identified some aspects of the relationship of Judaism and psychology present in a very few of the written Jewish texts.  From the Bible to the modern prayer book, it appears that Judaism reflects a holistic approach to issues of mental health: the dramatic and essential linkage between body, mind and spirit. According to Jewish thought, each has a bearing on the other and in many ways, seems to imply that it is possible to be “healed” without being “cured.”

At the heart of the discussions on Judaism and psychology is the point that all of the discussions regarding these issues return to a fundamental relationship with God:  both physical and mental health is a mitzvah to be kept in order to be able to fulfill one’s relationship with the deity.  While many of these beliefs may run counter to much of Western medicine, they are an essential foundation to understanding how Judaism approaches the interface between itself and mental health.

Many have speculated as to the philosophical cultural roots of psychotherapy.  It appears that freedom is a central and fundamental idea in the literature of both the ancient Greeks and Hebrews. But the way in which the two cultures understand and deal with freedom is very different. To the Greeks freedom is a struggle against the control of others and an effort to establish some sense of control over one’s life and the highest form of control over one’s self is the freedom to decide whether to continue to live or die, that is, suicide.  Judaism, in contrast, sees freedom as the central feature – our foundation.  In Judaism, life itself is the essence of creativity and suicide only destroys this opportunity. 

Psychology today has a tendency to pathologize anything which deviates from the Cartesian medical paradigm of mind/body dualism.   But perhaps it is a great injustice to the field to rob the psyche of its shadow, its evil side. The late Rabbi Shneerson spoke about this aspect of personality in terms of light and shadow (good and evil) and how we need to allow both in an attempt to create balance which then leads to harmony. The ancient knowledge of Judaism seems to have a great deal to offer the comparatively young field of psychology concerning human nature, the life cycle and “The Bible in Healing and Transformation.”