Tuesday, July 30, 2013

In Sickness and in Health - What Jewish Law Can Say about Psychology and Psychiatry

By Rabbi Ira Bedzow, MA


Rabbi Ira Bedzow
Rabbi Ira Bedzow is a 2013 recipient of the Emory Center for Ethics Neuroethics Travel Award. He is the project director for Moral Education research project for the TAG Institute, and is currently pursuing his PhD in Religion at Emory University.

While it is obvious that the term "insanity" expresses the value judgments of a society's legal system, psychology and psychiatry also accept social mores as a guideline for determining mental illness and health, even when their practitioners deny doing so.  For example, according to the DSM-5, mental illness is diagnosed by dysfunctional behavior (though some psychiatrists are pushing for a biological categorization of mental illness) and thus assumes social or cultural norms by which to interpret behavior in order to determine whether it is dysfunctional or not.  Because insanity and mental illness are both predicated on social norms, they are by definition determined by society's ethical posture.

In Jewish law, and in the Jewish tradition more generally, there is a rich debate over the nature of mental health and mental illness, which can provide insight into the ethical influence over diagnosing and treating mental illness.  In general, the key question found in Jewish juridical sources with respect to mental illness is how to understand a person's behavior and how to habituate different, healthier behavior.  Of course, this may not apply to major mental disorders, yet given the current critique, that the DSM-5 has psychiatrized daily life, this discussion would apply to certain less serious mood and addictive disorders.

At first glance, the criteria in the Talmud to determine whether a person is mentally ill seem to be behavioral; a person is mentally ill when he or she acts in a socially dysfunctional manner.  In the pursuant Talmudic discussion regarding how many symptoms a person must possess to indicate whether he or she has a mental illness, however, it becomes clear that behavior alone is not a marker; rather, the question is whether the person is capable of rational thought which can explain the abnormal behavior.  If a person has no rational explanation for his or her behavior, he/she should be regarded as insane; rational explanation would imply sanity.  Questions arise over the extent to which one can interpret a person's actions as rational.  (The Talmud gives the following examples: If the signs that a person is mentally ill are that he that goes out alone at night, or he spends the night in a cemetery, or that he tears his garments, then if a person actually does one of these things, it may nevertheless be possible to say, "He spent the night in a cemetery in order to perform magic, or he went out alone at night because he was seized with the need to go outside, or he tore his garment because he was lost in thought."  If, however, he performs all of these actions, it becomes much more difficult to provide rational reasons for his behavior.)

Rabbi Moshe Feinstein
Because rationality, and therefore insanity, is often dependent on interpretation, Jewish law provides a scale for mental illness, whereby a person could be considered sane in some respects yet not in others.  For example, in one of his responsum, Rabbi Moshe Feinstein discusses a case where a person seems to be completely normal except for the fact that he believes himself to be the Messiah.  The person would climb trees in order to give speeches to the people below and he would walk around naked claiming to emulate the first human being.  Rabbi Feinstein distinguishes between being capable of comprehending the purpose and worldview embedded within Jewish law and being capable of conducting oneself in a greater society, whereby the person engages in trade and has social responsibilities.  Because the person who claims to be the Messiah is unable to comprehend the mores and values of Jewish law, not that he does not believe in them but rather that he cannot understand them, he is exempt from its (Jewish law's) obligations by virtue of being mentally ill.  On the other hand, with respect to living in the greater society his transactions would be effective since he can understand social norms as any other sane person.  In this sense, he is both sane and insane, depending on the standard by which his behavior is judged.

From: www.i09.com
Rationality is an important marker for mental health in the Jewish legal tradition for two reasons.  First, the tradition acknowledges that all people naturally create cognitive schemata (worldviews) in which their thoughts and actions make sense to them.  Rationality, therefore, gives the person the ability to understand accepted social norms as well as the ability to understand his or her own behavior vis-à-vis those norms.  Second, rationality allows for free choice through which a person can change his or her habits.  Changes in habits are believed to create changes in a person's temperament and thinking.

If a person is incapable of rational thought, then adherence to Jewish law has no beneficial effects. If, on the other hand, a person is rational, then even if he or she has a mood or an addictive disorder, Jewish law is meant to be the means by which to return to full mental health.  From the perspective of cognitive behavioral therapy, Jewish law attempts to create small tests which allow a person to find success easily when he or she observes the law and allows the person to avoid the "What the hell" effect when he or she does not.  It is able to do this because the legal framework provides the ability to perceive each act as independent of the next, yet the totality of one's daily behavior still gives rise to a unified sense of living according to a measurable standard.  Also, Talmudic thinking, which allows for greater hermeneutical flexibility than other forms of reasoning, can allow a person to reinterpret negative experiences and make them pivot-points towards different choices.  The benefits of this type of approach in therapy has been explored recently in acceptance and commitment therapy.  (This is not to negate the possible benefits of psychopharmacology; however, psychopharmacology is completely cosmetic.  It does not cure a person, it only deals with his or her symptoms.  Once the patient stops taking medication, the symptoms will return.)

The influence of Jewish social values on the determination of mental illness and on treatment is demonstrated by the fact that the techniques to treat a mentally ill person (such as observance of Jewish law and interpreting experience so as to promote positive goal-oriented development) are the same as those used to improve a mentally healthy person's well-being.  Because the ethical posture of Jewish law is consistent, prescriptions for mental illness and health are on the same spectrum as those for human flourishing.  If the Jewish tradition can impart one insight to contemporary discussions in psychology and psychiatry, it should be that categorizing mental illness also sets the boundaries for what is normal.  Whether those boundaries are fixed by biology or by social markers, diagnostics must also entail a good look into what kind of society we want to be and what type of people we want to become.


Want to cite this post?

Bedzow, I. (2013). In Sickness and in Health - What Jewish Law Can Say about Psychology and Psychiatry. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/07/in-sickness-and-in-health-what-jewish.html

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