Mental Illness in Jewish Law (1)

by Dr. Rael D. Strous, Alumnus of Har Etzion 1998, the chief psychiatrist and medical director of the Mental Health Wing of Mayanei Hayeshua Medical Center

 

WHO IS A SHOTEH?

 

The nature and phenomenology of the "shoteh" is distinctly described by the gemara in Chagiga 3b.  The beraita [2] asks "Who is a shoteh?" and answers by initially providing three cardinal features: one who goes out alone at night, one who spends the night in a cemetery, and one who tears his clothes.  Later, a second beraita adds a fourth criterion: one who destroys all that is given to him.[3]

 

The definition of the shoteh that emerges from the gemara is symptom-oriented; it is based upon observable behavior.  No assumption as to the causation of the shoteh's illness is presumed.  As opposed to being a diagnosis rooted in pathophysiology or abnormal cognition, the term shoteh describes a phenomenological classification.

 

Therefore, from the discussion in the gemara, we can identify the shoteh as someone who manifests symptoms typical of the insane, or what in clinical terms we would call the psychotic individual.  Psychosis in this sense may be defined as being the state in which an individual lacks the ability to distinguish reality from fantasy.  This concept has also become clinically synonymous with an associated severe impairment of social and personal functioning, characterized by an inability to perform expected roles.[4] With gross impairment of reality testing and insight, the psychotic individual will incorrectly evaluate perceptions and thoughts, and in so doing, make incorrect inferences about external reality even in the face of clear evidence to the contrary.  Having described the shoteh in this manner, we see the shoteh as someone who is expected to struggle to meet societal expectations of functioning, and who would demonstrate impaired ability to cope with the usual frustrations and routine challenges of life.

 

In relating to such a challenged individual, halakhic norms and values demonstrate acute sensitivity, thereby displaying the general sensibility of halakha and its preparedness to address the range of human experience and occurrence.  This sensitivity manifests not merely in relation to the shoteh himself – thus protecting his rights, status and standing in the community – but also in the rights of the community which may find itself compromised at times by irrational acts carried out by psychotic individuals.  How precisely are these factors played out within the rubric of halakha?  What are the ways in which the shoteh is shielded from excessive unrealistic expectations extended to otherwise sane individuals?  We will briefly elaborate on some of these issues, with the awareness that our concise discussion will not do the subject adequate justice.

 

THE SHOTEH AS A HALAKHIC CATEGORY

 

After outlining the essential symptoms characteristic of a shoteh and associating these symptoms with the contemporary description of psychosis, we must now clarify who ultimately designates the shoteh as such.  According to the Rambam, the role of determining who is a shoteh is exclusively reserved for the judges of the beit din.[5] This ruling reflects how the phenomenological category of shoteh is not a clinical classification, but rather a legal concept.  Consequently, we do not turn to clinical professionals such as a psychiatrist, physician, or psychologist in order to establish whether someone is a shoteh.  However, this principle does not exclude clinicians from the world of the shoteh.  To understand their role, we must address the manner in which halakha determines the category of shoteh.

 

The halakha recognizes that psychotic symptomatology exists on a continuum and that this range of human behavior may express itself in a number of forms.  The Torah is sensitive to the individual nature of certain manifestations of psychosis and does not merely group all phenotypic expressions of psychotic illness together.  In fact, the application of the category of shoteh by the beit din is tied to the specific task for which the competence of the individual in question is being judged.  Furthermore, the halakha itself formulates several distinct categories of shoteh (we will elaborate the categories below).  Thus, the beit din has the responsibility to precisely recognize and typify overt symptomatology in order to facilitate optimal categorization.  Consequently, professional evaluation of the mental capabilities of an individual most certainly influences the particular legal status that the beit din will apply.

 

SUBTYPES OF THE SHOTEH

 

The recognition of the varied expression of psychosis led the sages to formulate several distinct categories of shoteh.  Based on our understanding that these legal categories must draw from the clinical reality, we will also attempt to clarify the clinical manifestations that best correspond to classification of the sages.

 

1) Shoteh gamur – the completely insane.[6] The chronic schizophrenic patient, whose prognosis remains poor and whose baseline functioning is seldom regained, perhaps best typifies the shoteh gamur.

2) Itim chalim itim shoteh – the shoteh who cycles in and out of psychosis.[7] This form of the shoteh is perhaps exemplified by the manic depressive or Bipolar patient, for whom the prognosis is generally good and who may be considered sane and competent when not cycling in the psychotic state.

3) Shoteh le-davar echad – the shoteh who is insane in only one domain, while remaining sane and coherent in all other areas.[8] The shoteh le-davar echad may be paralleled in the contemporary clinical malady of Delusional Disorder in which there is a fixed manifestation of non-bizarre delusions involving situations which may occur in real life, such as being followed, poisoned, infected, deceived, diseased etc.  This individual, despite remaining psychotic in a circumscribed area, may be adjudged competent to engage in certain other domains of responsibility and obligation which would otherwise remain 'off limits' to a shoteh.  

 

These categories are important as they determine various obligations expected and permitted to the shoteh, and designate roles potentially sanctioned.  Once this designation has been established, it becomes important to define precisely the halakhic duty and obligation expected of the shoteh.

 

HALAKHIC OBLIGATION AND RESPONSIBILITY

 

In rabbinic sources, the shoteh is frequently mentioned alongside the cheresh (deaf-mute) and the katan (minor), since, as the gemara explains, the members of this trio share the quality of being lav bnei da'at (lacking understanding).[9] Thus, the shoteh is deemed to be lacking in the critical judgement necessary for basic tasks of daily living and social adaptation, as well as the ability to assess a situation in a correct manner and act appropriately.

 

As a result of this characterization of the shoteh as one who lacks understanding, the shoteh receives a general exemption from all mitzvot.[10] This exemption applies to both positive commandments as well as negative commandments, any transgression of which would be adjudged ones.[11] In addition, the shoteh is exempt from certain forms of punishment.[12] The Mekhilta even extends this exemption to responsibility for murder under certain conditions.[13] The gemara details particular examples of mitzvot from which the shoteh is exempted, including the reading of the megilla[14] and re'iya (pilgrimage to the Temple).[15] Furthermore, the shoteh is exempt from participation in communal obligations such as zimun before Birkat Ha-mazon.[16]

 

We should note that while a shoteh is exempt from mitzvot while he is psychotic, once he remits from this state of psychosis he again becomes obligated.  For example, as cited by the Rambam and more recently by Rav Moshe Feinstein, a shoteh in remission would be obligated to eat matza again had he initially eaten while in a psychotic condition, a state in which he would be patur from the mitzva.  Since he is now in a position to comprehend the act, he is obligated in the mitzva and must eat again.[17]

 

The transition from the status of psychosis to one of sanity, and the reverse, has further halakhic implications.  For instance, if a sane individual is convicted of the death penalty in a murder trial and subsequently becomes psychotic, there are differing opinions as to whether the beit din can carry out the punishment while the murderer is in this psychotic state.[18]

 

While some may argue that the shoteh's exclusion from the obligation of mitzvot suggests an element of discrimination, we could conversely claim that this paradigm of halakha actually demonstrates sensitivity to the position of the shoteh.  The functionally impaired shoteh is not burdened unnecessarily by obligations which would only serve either to add a further stress to an already challenged psychological state of mind, potentially exacerbating the clinical picture, or to impede recovery from a current disabling psychotic illness.

 

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FOOTNOTES:

 

[1]  I would like to thank Ron Sher, Daniel Eisenberg, Rochie and Sholem Hurwitz for their assistance in writing this article.  My deepest thanks are reserved for my wife, Brocha, with whose wisdom, knowledge and support this has been possible.

[2]  Also found in Tosefta Terumot 3:1.

[3]  Chagiga 4a.

[4] Kaplan and Sadock's Synopsis of Psychiatry, Behavioral Sciences, Clinical Psychiatry. Harold I Kaplan, Benjamin J. Sadock, Jack A. Grebb. 7^th edition, Baltimore, Maryland 1994.

[5] Rambam, Eidut 9:9-10. The Rambam also cites the halakha that a shoteh is disqualified to offer testimony since he is not obligated in mitzvot.

[6] Rema on Even Haezer 44, Achi'ezer, Even Haezer 1:10.

[7] Ketuvot 20a, Yevamot 113b, Nedarim 36a, Gittin 5a, 23a, Rosh Hashana 28a, Yerushalmi Ketuvot 1:25b, Yerushalmi Gittin 2:44a. Note that the Talmud Yerushalmi appears to differentiate between chalim, incomplete remission, and shapoiy, full remission (see responsa of Rashba 4:201). Rambam Mekhira 29:5.

[8] For more in-depth analysis see Or Hayashar and Or Hayesharim discussing the case of the Get of Cleves.

[9] e.g. Yevamot 99b, Menachot 93a, Chulin 13a, Erkhin 2a, Erkhin 5b, Rashi on Chagiga 2a.

[10]     Chagiga 2b.

[11]     Pri Megadim, Introduction to Orach Chaim, Chelek 2, Siman 2.

[12]     Rashi, Chagiga 3b, "Eizehu shoteh"

[13]     Mekhilta, Mishpatim 4, cited in Mishpetei Hada'at.

[14]     Megilla 19b.

[15]     Chagiga 2a.

[16]     Mishna Berura 199:29.

[17]     Rambam Chametz Umatza 6:3, Igrot Moshe Even Haezer 2:18.

[18]     See Emek Halakha 1:32-33 which maintains that the death penalty comes as an atonement and therefore only applies to one who is obligated in mitzvot; for contrasting opinion, see also responsa of Tzafnat Paneich 19 which maintains that, based on the verse, "You shall eliminate the evil from your midst," the death penalty applies to all murders. Cited in Encyclopaedia Hilkhatit Refu'it, Avraham Steinberg.