British Journal of Medical Psychology (1992), 65, 22S235
Printed in Great Britain
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0 1992 The British Psychological Society
Mysticism and psychosis: The fate of Ben Zoma David Greenberg*, Eliezer Witztum and Jacob T. Buchbinder Jerusalem Mental Health Center, POB 35300, Jerusalem 91351, Israel
This paper examines the link between psychosis and mystical study through the cases of four young men who ‘entered the garden ’ of Jewish mystical speculation and subsequently became psychotic. The role of such study as a precipitating factor is suggested, as three had no signs of disturbance prior to their mystical studies. All had suffered personal losses, and their choice of mystical texts and rites showed that their attraction to mysticism included a search for atonement for guilt they felt over their loss. The features of normative mysticism are presented with each case and it is apparent that hallucinations, grandiose and paranoid delusions, and social withdrawal, are phenomena that do not distinguish the psychotic from the mystic. Diagnosis of psychosis is made on the basis of duration of the state, ability to control entry into the state and the associated deterioration of habits, particularly the neglect of daily religious duties. These findings emphasize the need for the examining psychiatrist to be aware of the cultural background, despite the presence of seemingly florid psychopathology. Four eminent Rabbis entered the garden of mystical speculation. Ben Azzai glimpsed and died. Ben Zoma glimpsed and was damaged (lost his sanity). Elisha ben Avuyah lost his faith. Rabbi Akiva departed in peace. (from Babylonian Talmud Hagiga 14b)
In the above Talmudic quotation, mystical speculation is seen to be dangerous for one’s physical and psychological welfare. Only one of the four rabbis was not adversely affected, and Ben Zoma became mentally ill (Ostow, 1988; Scholem, 1960). One section of the central Jewish mystical text, the Book of Splendour (Zohar), tells of three students who died during mystical ecstatic states. Mystics commonly hid their writings from the general population, and Jewish religious authorities, aware of the dangers, declared that mystical texts should only be studied by people who were stable in all areas of their lives: aged over 40, married and having thoroughly studied all basic Jewish texts for many years (Scholem, 1961). Mystical studies and experiences have dangers for the individual and the community. For the individual, the risks would seem to arise from the absorption in the unseeable and unprovable, the entry into ecstatic states, including seeing visions, and the loss of boundaries, which test the person’s link with his daily duties and realities (Ariel, 1988 ; Schneiderman, 1981). The structure of authority within the * Requests for reprints.
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community is also threatened, as the mystic achieves a closeness to God that may not be experienced by religious leaders (Scholem, 1967). Furthermore, the veracity of any claimed revelation is unprovable, a problem that faced religious leaders at the time of the pseudo-messiah Sabbatai Sevi (Scholem, 1973). The challenge to authority led rabbis to rule that rabbinic authority always overrides mystical experience. The relationship between mysticism and religion is seen to be complex the mystical experience is perceived as a deepening of normal religious life yet also destabilizing. William James (1982), in his pioneering study of religious experiences, noted that mystical states have several characteristic features : they cannot be adequately described or appreciated (ineffable), and there is a sense of revelation of knowledge hitherto unknown (noesis). These features create a divide between the mystic and the onlooker: does society react with acceptance or doubt? Is the mystic normal or abnormal ? The authors present four cases of young men who left secular lives to become ultra-orthodox Jews (known as ‘religious penitents’). In the course of their change, they immersed themselves in intensive mystical study and eventually became psychotic. The cases are viewed in order to examine the following issues: ~
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Does mystical study precipitate mental illness or does it appeal to the mentally unstable whose attraction to mysticism is part of their psychotic withdrawal ? What is the effect of local religious attitudes towards mysticism on the development of psychopathology? How do religions distinguish between the mystic and the psychotic?
Mysticism and psychopathology It has often been noted that the more central the role of culture-specific beliefs and behaviours in a society, the less likely they are to be associated with severe psychopathology (Leff, 1988). If having visions is normative, then it is unlikely to be a feature of psychotic illness (Kroll & Bachrach, 1982), and the converse is also true. So too with mysticism. Mystical experience is a central feature of Buddhism - the term Buddha means ‘enlightened one’, referring to the crucial mystical experience of its founder, Siddharta Gautama; while in Hinduism the seminal text, the Bhagavadgita, contains a mystical vision. Both religions contain meditation in everyday life and the mystic is an unremarkable member of society. This is not so in the modern Near Eastern religions. While mystical experiences are valued in Christianity, Judaism and Islam, they ;re treated with caution. The founders are reported as having had mystical revelatory experiences, but the religions emphasize rituals and social codes. While prayer is central in all three, none include meditation nor encourage attaining mystical experiences. Muslim authorities were concerned that novice mystics would suffer excessive elation and despair arising out of the mystical states of ‘expansion’ and ‘contraction’, and Quashayri, an 11th-century mystic, described expansion as ‘the greatest danger’ (quoted in Zaehner, 1961). The Christian authority most aware of the danger of mystical states was St John of the Cross, a 16th-century mystic, who described the intense depression experienced by the mystic yearning for union with God, a state he termed ‘the dark night of the
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soul’ (1973). In an analysis of the lives of prominent Christian mystics such as St Catherine of Genoa, St Teresa and Mme Guyon, Leuba (1925) concluded that they suffered hysterical episodes. It is the similarity between mystical and psychotic states, however, that has received most attention, as social withdrawal, delusions, hallucinations and strange behaviour are common to both (Buckley, 1981 ; Sedman & Hopkinson, 1966a, b). Features considered specific to mystical states are often found in psychosis : noesis may be experienced at the onset of psychosis (Bowers & Freedman, 1966; Buckley, 1981), so too unio mystica, the sense of mystical union with God prominent in Christian mysticism (Dupre, 1989 ; Fenichel, 1946). Certain features have been thought to differentiate between the mystic and the psychotic state. Although these observations are based on impression alone, they are presented for contrast with the ensuing cases. (I) Hallucinations are common to both ; while psychotic hallucinations are predominantly auditory, mystical hallucinations are commonly visual and their content is usually elderly people, who are benevolent counsellors (Arieti, 1976). (2) Glossolalia, or speaking in tongues, noted in mystical states in Christian revivalist groups, is distinguishable from psychotic thought disorder in that the former is incomprehensible, representing a language unknown to the speaker (Littlewood & Lipsedge, 1989). (3) The choice of words used by the psychotic and the mystic differs significantly. While the mystic tends to describe his experience using terms such as God, Christ, peace, soul and spirit, the psychotic’s description uses terms of illness and deviance (Oxman, Rosenberg, Schnurr, Tucker & Gala, 1988). This claim, however, was based on reports written by patients after their psychosis, and is in contrast to earlier reports, in which this distinction was not apparent (Bowers & Freedman, 1966). (4) Delusions of personal grandeur and omnipotence may be features of paranoid psychosis. They are unusual in the mystic, who views himself as a privileged vessel who must negate his own importance and not give way to self-flattery. (5) The affective responses may also differentiate the two: the mystic experiences ‘joy and sweetness’ or ecstasy (Buckley & Galanter, 1979; Wulff, 1991), while the psychotic may be terrified or indifferent to his psychotic experience. Bowers & Freedman (1966) noted that ecstasy was often present initially, and was then replaced by dread. (6) The mystical experience is transient (usually hours) and resolves completely, while psychotic states may last months or years, and will often leave residual delusions, flattening of affect or reduced social functioning. (7) Finally, the withdrawal of the mystic has been described as ‘facultative rather than obligatory’ (Group for the Advancement of Psychiatry, p. 784). Unlike the isolated psychotic, the mystic desires to share his experience with fellow mystics (Group for the Advancement of Psychiatry, 1976). While brief duration and absence of deterioration may distinguish mystical states from schizophrenia, this distinction does not apply to schizophreniform disorders, leading Buckley (1981) to speculate that both mystics and sufferers of brief psychotic episodes may be responding to ecstatic affective changes. Similarly, Lukoff (1985) has claimed that some psychotics are undergoing predominantly religious
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experiences ; they should be spared medication and instead helped to grow spiritually through their experience. While appealing, the view of psychosis as a lunge for health is not novel (Laing, 1965) yet remains undemonstrated.
Mysticism in Judaism Although the mystical tradition was widespread among Jewish communities, it has been most consistently accepted and studied among Oriental Jewish (Sephardi) communities. The main mystical text, the Book of Splendour (Zohur), is read daily in communal services and at all celebrations, and groups of young men are encouraged to study it regularly in Sephardi communities, in contrast to the restrictive attitudes in the Ashkenazi (European) communities described in the introduction (Chouraqui, 1975 ; Stahl, 1980). Jewish mysticism may be divided into two themes: theosophy and theurgy (Idel, 1988). In the theosophic element, the Jewish mystical lore known as kabbalah discusses such concepts as how and why God created the world, the principles and means for God’s ongoing maintenance and control of the creation, and the inner meanings of religious rituals. In addition, there is a body of practices known as folk kabbalah, which at a sophisticated level is concerned with theurgy, i.e. influencing God’s actions in the world, bringing redemption and overcoming evil, but which also flourishes at the personal level of cursing enemies, healing ills and wearing good luck charms (Hillel, 1990; Trachtenberg, 1974). The following cases are presented to identify specific areas of mystical study and practice that may consume the mentally ill patient, and confuse the assessing psychiatrist. In each case, the biographical and phenomenological details are presented, followed by an account of the relevant features of Jewish mysticism.
Case presentations Case 1 : PersecutoT hallucinations or demons 1 A 28-year-old of North African origin, born in France, married with two children, unemployed, began compulsory army service as an electrician and rose to the rank of staff-sergeant. His brother went missing during military action when the patient was 13. When aged 25, he converted to ultra-orthodox Judaism, and began visiting cemeteries throughout Israel in search of his brother’s lost tomb. His brother often ‘appeared’ before him and told him where to look. Whenever he located a site, he would light candles and remain there for the night conversing with his brother in order to ‘repair and elevate his brother’s soul’. A year later, he joined a fringe hasidic sect, and a few months later he was introduced to his wife and married. When his wife became pregnant, his brother appeared and told him that a son would be born, and he would be given the brother’s name. When, instead, a daughter was born, he refused to see her o r refer to her, and left home. He believed the birth of a daughter to be a punishment for his sexual activities, particularly masturbation, during the years before he became religious. An angel appeared to him, threatening to break his bones. He believed his situation to be ‘beyond repair’ (see Case 2). O n examination, he was unkempt, bowed over with his eyes fixed on the ground. He appeared
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depressed, barely replied, and his rare responses were brief and mumbled. He reported auditory and visual hallucinations : his brother appeared and told him not to take medication, and a band of angels also visited, including his personal angel who beat him. His rabbi ordered him to visit the tomb of the Jewish mystic, Rabbi Shimon bar Yochai, and he became slightly calmer. He was then taken to the tomb in Russia of Rabbi Nachman of Bratslav, founder of the sect he had joined. He has not returned to the clinic and his rabbi has informed us that he is largely unimproved two years later. Diagnosis. Depressed mood, concern with guilt and punishment and moodcongruent hallucinations, which are second-person throughout, are indicative of major affective disorder with psychotic features, while the paranoid content of the psychosis, the predominance of the withdrawal into psychosis and the chronic deterioration are consistent with paranoid schizophrenia.
Mystical background. Demons and evil spirits are an unquestioned component in the Talmud (3rd-5th century), and subsequently mystical works accorded demons a role in the cosmic design, representing the left side of creation, ‘the other side ’, or the force of evil, as opposed to the side of right and holiness. The Zohar states that demons are created by improper sexual relations and that demons arousing a man’s passions at night cause nocturnal emissions, whereby more demons are created from the spilt seed (Trachtenberg, 1974). During our clinical work we have noted that masturbation, regarded in Jewish religious literature as the ‘defect in man’s covenant with God’, and other sexual activity carried out prior to conversion to ultra-orthodox Judaism trouble our patients greatly after conversion and they are particularly frightened by the demonological consequences. The patient’s nocturnal visits to cemeteries in search of his brother were given a culturally acceptable form when his rabbi told him to visit the tombs of eminent mystics. The hasidic group he had joined encouraged such visits, as its founder, Rabbi Nachman, had visited the tombs of mystics to invoke their prayers on behalf of the Jewish people (Green, 1981). The concern with continuing his father’s name is consistent with the importance attached to names in the mystical tradition: the name of revered ancestors is given to descendants, while if a person is dangerously ill, his name is permanently changed. ‘His name is the mainspring not only of a person’s character, but also of his fate’ (Trachtenberg, 1974, p. 78). Case 2: Delusions of grandeur or ‘ Repairing the world’
A 26-year-old, unemployed man, recently married, ultra-orthodox for the past year was reported by his wife as behaving strangely over the last four months, had ceased studying and barely spoke. Of Sephardi Bulgarian stock, he completed school and army service without problems, but then immersed himself in the study of cults, such as Iman, and in the philosophy of the occult, such as the writings of Gurdjieff. A year previously he had converted to ultra-orthodox Judaism, and immediately ‘entered the garden ’ of mystical study. His behaviour changed : he would sit on the floor and
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cry over trifling matters, he visited cemeteries around Jerusalem with invisible companions in order to study kabbalah, and complained that the soul of a dead friend had transmigrated into his body, saying: ‘I have been impregnated by a spirit’. He undertook the ‘repair of spirits of the sinful who had died’ and to this end he pronounced the ineffable names of God and carried out prayers of unification with God, which he had collected from books on folk kabbalah. He became depressed and introverted, withdrew from all social contact, and began to wash his hands repeatedly until his skin bled. He was distressed when he lay on his bed at night and heard cries that asked him to repair dead souls. O n examination he was unkempt, avoided eye contact and stared at the floor. He was depressed and sighed despairingly. His answers were brief and sporadic, and he said that the sorrow he could express was but a part of what he felt over his failure to repair souls. He was deluded and hallucinated, stating that he studied kabbalah with the prophet Elijah and heard the cries of the spirits calling for his aid. He received a low dose of neuroleptic medication, and was advised by his rabbi to stop studying kabbalah. He became calmer, tidier, said that the cries had become softer and he could no longer make out what they were saying. He was less perturbed by the demons created by the sexual excesses of others, although concerned by the masturbatory errors of his own earlier ways. His hand-washing decreased and his relationship with his wife improved. He refused to increase the dose and dropped out of treatment. His wife understood his situation as follows : he was neither strong spiritually nor did he know kabbalah sufficiently, so that he failed in his mission and ‘fell’. Diagnosis. The same issues that were discussed in the first case are pertinent here: depressed mood, concern with sin and failure, and mood-congruent delusions and second-person hallucinations are suggestive of major affective disorder with psychotic features, while the chronic psychotic withdrawal and persecutory delusions and the partial effect of medication are indicative of paranoid schizophrenia.
Mystical background. Transmigration of souls from one body to another is an ancient concept, known in Sanskrit as ‘samsara’. Its use in early kabbalistic texts was limited to the transfer of the soul of a dead body to a live one as a punishment or in order to make retribution for sins, mainly sexual. The concept, known in kabbalah as ‘gilgul’, was broadened by the 16th-century mystic, Isaac Luria, to include the opportunity for all souls to g o back and complete their tasks on earth, known as ‘tikkun’ (repair) (Scholem, 1961). The books of Luria’s pupils are still studied today. Tikkun was a metaphysical concept developed by Luria, describing ‘the process of cosmic restoration and reintegration ’ (Scholem, 1961). Later, however, the term gained a more popular meaning: it is related that the souls of the dead who were suspended, neither able to enter paradise nor transmigrate, would come in droves to the Baal Shem Tov (‘the Master of the Good Name’, 18th-century founder of hasidism) and beg him to ‘repair’ them so that they could find their eternal rest in paradise. He succeeded in ‘ repairing’ their souls, presumably through prayer or magical means (Dov Baer ben Samuel, 1970).
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Case 3 :Halhcinations or revelations and personal angelJ A 24-year-old unemployed man who had converted to ultra-orthodox Judaism two years previously, married with a baby daughter had, six months prior to referral, begun to devote himself exclusively to kabbalistic study, particularly the Zohar and two works by Vital, pupil of Luria, the Book of Visions and the Book of Transmigrations. Following his daughter’s birth, he was disappointed, isolated and depressed. He said that he heard voices, and spent his time fasting, lighting candles and in imposed silence without changing his clothes. Of north African descent, he described his father as an alcoholic, who was often violent at home. When he was 15, he found his father dead after an alcoholic stupor. At the time, he blamed himself, was depressed and became addicted to opiates. When he became ultra-orthodox, he ceased all drug abuse, married, and when his wife became pregnant he hoped for a son to name after his father (see Case 2). Following his daughter’s birth, he started hearing voices that told him that, while every man has a personal angel, his angel’s task was to punish him for his father’s death; it instructed him to fast by eating no more than the size of an olive of food. He began to visit the tombs of Jewish mystics, where he would light candles and remain for hours. O n examination, he was unkempt, depressed, partially oriented and not fully cooperative. He barely answered questions, although he said that he had sinned and did not deserve to live. He reported hearing his angel’s voice by day and saw his father dressed in black in dreams. He received a low dose of a neuroleptic and was asked to write a letter to his father in which he asked him for forgiveness and permission to carry on living. His therapists and the patient’s brother, himself a Rabbi, explained to him that grief after the year of mourning is a contravention of Jewish law. During the next week he wrote his father a frank and moving letter, telling him of his personal angel and his fear that the angel would turn him by transmigration into a stone following his death. In order to understand the symbolic significance of his angel, and to bring it under mystical control, he was asked to cooperate in establishing the true identity of his angel : was he for the patient’s benefit or was he a demon? He told the therapists that he was able to summon his angel by lighting 12 candles and reading from the mystical text The Book of the Angel Raxiel and he did so during a therapeutic session. He gradually improved (see Witztum, Buchbinder & Van der Hart, 1990). Diagnosis. Depressive mood, guilt feelings, withdrawal, second-person persecutory mood-congruent hallucinations indicative of major depressive disorder with delusional features.
Mystical background. There is an intrinsic conflict between the concept of an abstract formless God and the existence of mystical-revelatory experiences. Nevertheless, even Maimonides, the 12th-century philosopher and codifier of Jewish law, himself a critic of mysticism, recognized a hierarchy of revelatory experiences: Moses as a prophet and the revelation o n Mount Sinai; other Biblical prophets; the holy spirit of the late Biblical period; the divine voice (‘bat-kol’) revealed to rabbis of the Talmudic era ;finally, experiencing the prophet Elijah. Kabbalists added a lower level
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of ‘the divine strength dressed as a man’. It is notable that this table of decreasing levels of revelation is also chronological, in keeping with the tendency to view the present generation as less holy and more sinful than its predecessors. Kabbalists were content to experience Elijah’s presence, to hear but a voice, without expecting to see a vision of light. They did not break the accepted code of the hierarchy of revelation, and did not report meeting or speaking with God. Instead they reported experiencing angels, and later still, they described the phenomenon of the Maggid. Early mystical literature relates the biblical reference to the ‘image of God’ in the creation of man to the existence of a personal angel, by means of which God controls every man’s life; God creates man’s image twice: one is the man, the second is his angel (Trachtenberg, 1974). A Maggid is an angel or superior being that reveals itself to a kabbalist in order to reveal secrets of the Creation through the media of a heard voice, automatic speech o r automatic writing. Common during the 16th-18th centuries, the most famous example was Rabbi Joseph Karo (Werblowsky, 1977), whose colossal academic achievements, and stable social and family status suggest he was not mentally ill (Lewis, 1978).
Case 4 :Psychotic behaviour o r theurgy A 23-year-old single man, religious penitent for four years, complained of worsening concentration, sleep and appetite as he was disturbed by voices that gave him instructions. Of Iranian origins, he was an unruly child, although he successfully completed his matriculation. He served in the army as a parachute instructor, and witnessed the death of a close friend in a terrorist border ambush. He became depressed and irritable and at that time he became increasingly interested in Bratslav Hasidism and aged 21 he began studying in a Bratslav academy (Witztum, Greenberg & Buchbinder, 1990). Shortly before referral, he started having a recurrent nightmare: soldiers on patrol fall one by one, including his dead friend. The patient also falls and is lifted on to a stretcher. O n examination he was neatly dressed. He appeared depressed, spoke in a monotone and with an air of despair. He described hearing voices which instructed him to kill himself and others. He received a low dose of neuroleptic medication. At his second visit he disclosed the following: For some months, he and a friend had been studying Jewish mystical texts, including the Zohar and works by Vital such as the Book of Visions and the Book of Transmigrations. After reading the section in the Zohar interpreting the Biblical text : ‘When you g o out to wage war with your enemy ’ (Deuteronomy, 21 :10) as dealing with the Satanic forces, the two decided that they too would go to war against the forces of evil, and attempt to hasten the redemption. Trained as a scribe, he wrote out God’s name on parchment as dictated by the Zohar, one text written in the shape of a sword. The pair intended using these amulets to call up the Lord and Lady of the ‘other side’, Samael and Lilith, in order to destroy them. O n the night appointed for the ‘battle’, the two friends recited the devotional prayers and went to sleep in a state of tense anticipation. A frightening vision appeared before him: pursued by a figure of fire surrounded by flames, he tried to wake up; a second vision followed: a column of men dressed in ancient bizarre clothing, some blind, others totally bald. All stood and stared. Then came the figure of fire, shouting : ‘You thought to destroy me ; it is I who will destroy you ! ’ ‘The
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sword’, he added with a groan while telling his story, ‘it was double-edged’. Since then, demons have pursued him day and night. Their form is constant: blind, hairless, ugly and hatted, telling him to kill others and himself, that they will make him mad and that he will go to hell. His partner suffered similar visions, became psychotic and was hospitalized. Leading kabbalists whom they consulted around the country were appalled that the two had attempted what great Rabbis had not dared and they offered no advice, except an ancient remedy of fasting for which he felt too weak. He explains what befell himself and his friend as what happens to the weak ‘who glimpse and are damaged’ (the Talmudic description of Ben Zoma’s fate). ‘The vessel was too weak to handle so much light; it cracked and was then smashed to smithereens ’. Diagnosis. Depressed mood, sleep and appetite changes, mood-congruent hallucinations, which gave him instructions, good recovery, suggestive of schizoaffective disorder. His psychotic partner in study was the more active of the duo, but the continuation of our case’s symptoms for months after the two friends separated rules out ‘folie P deux’. Mystical background. In Judaism, God is perceived as an absolute unity, and supernatural forces and creatures of evil are subject to God’s dominion (Short, 1982). The problem of the creation and existence of evil in the world is an important theme in Jewish mystical writings : evil is a necessity without which there would be no free will for choosing the good path. In kabbalah, the realm of evil, called the ‘other side ’, is distinct from holiness, yet is produced by God. Acts to call upon God and destroy the forces of evil are described in the lives of mystics and particularly hasidic leaders (Buber, 1947), although discouraged in the general population by religious authorities (Hillel, 1990). The salutary account of a Jewish mystic who used theurgic practices to bring about the redemption was related of Joseph de la Reyna, a 15th-century kabbalist. He was said to have taken five pupils into the desert, where they purified themselves. Using mystical acts, they summoned the Lords of Demons, Samael and Lilith, in the form of black dogs. They tied the couple up, but, in a moment of weakness, Joseph allowed them to sniff a grain of frankincense he was holding, they untied themselves and disappeared. The account ends that Joseph was punished and lost his faith (Benayahu, 1972 ; Scholem, 1933). The use of amulets containing parchment with written texts including the names of God and protecting angels has been popular since medieval times in protecting against the forces of evil. They are commonly requested at times when ‘Satan accuses ’ such as birth, circumcision, illness, a long journey or the death and burial of a close relative.
Discussion Four cases are presented of young men who began to study Jewish mysticism and became severely psychiatrically disordered. Aged between 23 and 28, all males, they were born in non-religious homes. In three cases, there was no apparent family psychiatric history, although collateral information was scant as the patient was brought by fellow penitents or rabbis who had not known them prior to their change
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to ultra-orthodoxy. With the exception of drug abuse in one case, their teenage years had apparently been uneventful and they had successfully completed army service, including promotion to officer status, reflecting a superior level of functioning. It is not uncommon for psychiatric disorders to emerge during the stresses of military service, so it is noteworthy that this did not occur. The clinical picture in all four cases was severe: vivid visual and auditory hallucinations, paranoid delusions, social withdrawal, and in the last three cases there was a marked deterioration of habits, with neglect of hygiene, clothing, and a cessation of the basic practices of Judaism and of religious study. Three cases received low doses of neuroleptic medication, with improvement in the interest they took in their surroundings, hygiene and religious practices. Hallucinations persisted, which may be due to the low doses of medication. It is possible that they refused to increase their medication and its effects as they were deeply drawn to their hallucinatory experiences. Similarly, their wives, fellow students and rabbis often continued to ascribe a sanctity to them. In our experience, however, while rabbis may have initially related to the experiences as mystical, once they perceived the prolonged duration of the withdrawal and the cessation of regular religious practice, they became convinced that the state was pathological, and they were committed to the need for psychiatric treatment. Does mystical study precipitate mental illness or does it appeal to the mentally unstable whose attraction to mysticism is part of their psychotic withdrawal ? It is remarkable that three patients reported the deaths of close friends or family, and the fourth referred to the soul of a dead close friend. In one case, mystical study followed immediately after the death, and in three cases the mental deterioration followed subsequent marriage o r childbirth. Two cases expressed overt guilt at the deaths (case 4 considers his friend may have been killed in the ambush by his own bullet). The conceptual explanations of Jewish mysticism for death and sin were of immediate appeal to our tortured patients : their sins created demons, their behaviour and repentance could alter the course of events. They changed concepts into concrete forms, and the guilt in their pathological grief was symbolized by devils (from past sins) trying to kill them, and drove them to the tombs of mystics. Their recent religious penitence may well have been an attempt to atone, and the birth of their first daughter instead of a first son, who is a gift to God in the Jewish religion (Exodus 13:2), is experienced as a lost opportunity for further repentance and proof of their unworthiness. Aberbach (1987) noted many similarities between grief and mystical states : depression, searching for the hidden one, withdrawal and detachment, visions of union, and identification with the dead (or God), and, finding that most mystics had suffered early losses of their parents, he suggested that ‘loss may be an important, even crucial, factor inclining an individual to mystical withdrawal’ (p. 510), and that ‘mystical union is a transcendent expression of grief’ (p. 515). Three cases became increasingly orthodox gradually, and their mystical study was a late component of this religious development. It appears that this process was simultaneous with their incipient psychosis, and their mystical state reflected their increasingly spiritual and decreasingly pragmatic concerns. The remaining case turned to mystical study at a time of crisis after the death of a friend. Considering their problem-free army service, it seems that our patients all had unresolved grief responses which were reactivated by the message of kabbalah that
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the souls of the dead not only live on, but can be repaired by man’s intervention. In this way, it may be that an interest in kabbalah may precipitate or aggravate psychosis. The increasing interest in the occult in the last decades has brought many young men to study kabbalah in Jewish religious institutes of study. Therefore, many study kabbalah, and only a few are referred for help. It is noteworthy that most of Jerusalem’s institutes for religious study are situated in our catchment area, including institutes for religious penitents. A recent clinic sample did find more mental illness among religious penitents (Witztum, Greenberg & Dasberg, 1990). A prospective study comparing the rate of mental illness in students of kabbalah and other matched controls would be necessary to ascertain if students of mysticism are more likely to develop psychiatric problems. Premorbid testing would establish if unstable people are attracted to the subject. Only the unlikely design of random allocation to mystical or non-mystical studies would demonstrate the effect of mystical study alone. What is the effect of local religious attitudes towards mysticism o n the development of psychopathology ? All four cases came from Sephardi homes : two from North Africa, one from Iran and one from Bulgaria. In Ashkenazi communities, mystical study is discouraged and restricted, and Ashkenazi Jews are often ignorant of its role in Judaism. In Sephardi communities, these restrictions d o not exist, and the major mystical texts have a respected role in everyday life. Similarly the practice of folk kabbalah, such as the wearing of amulets and turning to folk healers at a time of illness are more accepted within the Sephardi community, religious and secular. Superstitious beliefs such as tempting the devil, transmigration of souls, possession, fortune telling, evil eye, amulets, lucky numbers and walking under ladders are more commonly held by Sephardi than Ashkenazi adolescents and these beliefs increase during adolescence (Zeidner & Beit-Hallahmi, 1988). We conclude that the attraction that mystical study and practices hold for Sephardi religious penitent referrals in our report reflects the familiar place of the Zohar and mystical beliefs in Sephardi society. The religious penitent Sephardi Jew is more drawn to the study and practice of kabbalah than his non-penitent born-religious Sephardi counterpart. This may reflect the enhanced yearning of the spiritual seeker who comes to religion as an adult in contrast to the more habitualized practice of the born-religious. Alternatively, the intense mystical pursuit of the religious penitent may merely reflect a new avenue for those suffering from a long-standing psychopathological process. Ongoing studies aim to gain a deeper understanding of the life histories, conversion process and subsequent religious direction of mysticpatients and non-patient Sephardi religious penitents. How d o religions distinguish between the mystic and the psychotic ? We have learned that mystical texts and their study are an integral part of the Jewish religion. They are seen as a means for the committed Jew to gain greater understanding of the essence of God as he appears to mankind through creation and revelation. The great Jewish mystics have included eminent Rabbis, famed for their knowledge and observance of the ritual aspects of Judaism (Werblowsky, 1977). It is clear, therefore, that an absorption in mystical study per se may be acceptable and respected behaviour within the Jewish community. In contrast, the deterioration of habits, particularly the neglect of religious ritual
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in our patients, was an indicator of disturbance. Related aspects of Jewish mysticism were presented after each case, and these demonstrated that the terminology and behaviours of our patients were products of their studies. So much so, that in two of the cases teachers of mysticism continued to give them advice, e.g. fasts and visits to tombs were prescribed as appropriate responses to their sorrows until advanced stages of their conditions. The symbols and language that they used were typical of mystics and may well have been learned and expressed in the same terms as their fellow students. Reflecting its integrated social status in Sephardi society, mystical texts are taught by a sage in groups. The provision of guidance and the practice of learning in groups and pairs serve to create a framework that establishes the study as normative, support its members and control the content. The isolation and independent study of our patients were early signs of disturbance. Although amulets are commonly worn in Israel, the active use of magic (folk kabbalah) is expressly forbidden by rabbis: ‘Demons start up only with those who start up with them, such as by writing amulets, practising sorcery o r asking dream questions. Therefore one should not engage in these practises ’ (Sefer C h i d i m 469, quoted in Hillel, 1990, p. 47). The patient who dabbled in magic did so without guidance. O u r study supports the observations of Murphy (1967) : the content of delusions and hallucinations may not differ from cultural norms. All of our cases developed delusions and hallucinations, apparently bizarre and pathological. Perusal of the concepts and practices of Jewish mysticism reveals that their thoughts of demons, angels, etc., were acceptable within the sects that they had joined (delusory cultural beliefs). The pathognomonic features were the accessory details : neglect of their other studies and practices, study in isolation and without guidance, and the suspect practice of folk kabbalah.
Acknowledgement The authors wish to thank the Latner Foundation for their continuing support for this project.
References Aberbach, D. (1987). Grief and mysticism. International Review of Psychoanalysis, 14, 509-526. Ariel, D. S. (1988). The MysticQuest: A n Introduction to Jewish Mysticism. Northvale, N J : Jason Aronson. Arieti, S. (1976). Creativio: The Magic Synthesis. New York: Basic Books. Benayahu, M. (1972). ‘Ma’aseh Nora’ of R. Joseph dela Renia. Aresheth, 5 , 170-188. Bowers, M. B. & Freedman, D. X. (1966). ‘Psychedelic experiences’ in acute psychoses. Archives of General Pryrhiatry, 15, 240-248. Buber, M. (1947). Tales ofthe Hasidim: The Early Masters. New York: Schocken. Buckley, P. (1981). Mystical experience and schizophrenia. Schixophrenia Bulletin, 7 , 516-521. Buckley, P. & Galanter, M. (1979). Mystical experience, spiritual knowledge, and a contemporary ecstatic religion. British Journal of Medical Psychology, 52, 281-289. Chouraqui, A. (1975). The Saga ofthe Jews ofNorth Africa. (Hebrew: Korot hayehudim bitsfon Africa). Tel Aviv : Am Oved. Dov Baer ben Samuel. (1970). I n Praise of the Baal Shem Tov. (Hebrew: Shivhei H a - k s h t ) (Transl. and edited by D. Ben-Amos & J. R. Mintz). Bloomington: Indiana University Press. Dupre, L. (1989). The Christian experience of mystical union. Journal of Religion, 69, 1-13. Fenichel, 0 . (1946). The Psychoanalytic Theory of Neurosis. London: Routledge & Kegan Paul. Green, A. (1981). Tormented Master: A Lye of Rabbi Nachman of Bratslav. New York: Schocken.
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Group for the Advancement of Psychiatry. (1976). Mysticism : Spirituul Quest or Psychic Disorder?, vol. IX. Publication no. 97. New York: Mental Health Materials Center. Hillel, Y. (1990). Faith and Folly: The Occult in Torah Perspective. Jerusalem: Feldheim. Idel, M. (1988). Kabbalah: New Perspectives. New Haven, CT: Yale University Press. James, W. (1982). The Varieties of Religious Experience. New York: Penguin American Library. John of the Cross (1973). The Dark N k h t of the Soul (Trans]. B. Zimmerman). Cambridge: Clarke. Kroll, J. & Bachrach, B. (1982). Medieval visions and contemporary hallucinations. Psychological Medicine, 12, 709-721. Laing, R. D. (1965). The Divided SeF London: Penguin. Leff, J. (1988). Psychiatry Around the Globe: A Transcultural View, 2nd ed. London: Gaskell. Leuba, J. H. (1925). The Psychology of Religiorrs Mysticism. London: Routledge & Kegan Paul. Lewis, A. (1978). Psychiatry and the Jewish tradition. Psychological Medicine, 8, 9-19. Littlewood, R. & Lipsedge, M. (1989). Aliens and Alienists, 2nd ed. London: Unwin Hyman. Lukoff, D. (1985). The diagnosis of mystical experiences with psychotic features. Journal of Transpersonal Psychology, 17, 155-181. Murphy, H. B. M. (1967). Cultural aspects of the delusion. Studium Generule, 10, 684492. Ostow, M. (1988). Four entered the garden : Normative religion versus illusion. Conservative Judaism, 40, 35-46. Oxman, T. E., Rosenberg, S. D., Schnurr, P. P., Tucker, G. J. & Gala, G. (1988). The language of altered states. Journal of Nervous and Mental Disease, 176, 401408. Schneiderman, L. (1981). The Psychology of Myth, Folklore, and Religion. Chicago : Nelson-Hall. Scholem, G. (1933). To the affair of R. Joseph dela Regna. Meassef Zion,5, 124-131. Scholem, G. (1960). The four who entered paradise and Paul’s ascension to Paradise. In Jewish Gnosticism, Merkubah Mysticism, and Talmudic Tradition. New York : Jewish Theological Seminary. Scholem, G. (1961). Mujor Trends in Jewish Mysticism. New York: Schocken. Scholem, G. (1967). Mysticism and society. Dialogue, 85, 1-24. Scholem, G. (1973). Sabbatai Sevi: The Mystical Messiah. Princeton, NJ : Bollingen Series XCIII. Sedman, G. & Hopkinson, G. (1966~).The psychopathology of mystical and religious conversion experiences in psychiatric patients : A phenomenological study. I. Confniu Prychiatrica, 9, 1-19. Sedman, G. & Hopkinson, G. (1966b). The psychopathology of mystical and religious conversion experiences in psychiatric patients : A phenomenological study. 11. Confnia Psychiatrica, 9, 65-77. Sharot, S. (1982). Messianism, Mysticism, and Magic. Chapel Hill : University of North Carolina. Stahl, A. (1980). Ritual reading of the Zohar. Pe’amim, 5, 77-86 (Hebrew). Trachtenberg, J. (1974). Jewish Magic and Superstition: A S t u 4 in Folk Religion. New York: Atheneum. Werblowsky, R. J. Z. (1977). Joseph Karo: Lawyer and Mystic. Philadelphia, PA: Jewish Publication Society of America. Witztum, E., Buchbinder, J. T. & van der Hart, 0. (1990). Summoning a punishing angel. Bulletin of the Menninger Clinic, 54, 524-537. Witztum, E., Greenberg, D. & Buchbinder, J. T. (1990). ‘A very narrow bridge’: Diagnosis and management of mental illness among Bratslav Hasidim. Psychotherapy, 27, 124-131. Witztum, E., Greenberg, D. & Dasberg, H. (1990). Mental illness and religious change. British Journal of Medical Psychology, 63, 33-41. Wulff, D. M. (1991). Psychology of Religion. New York: Wiley. Zaehner, R. C. (1961). Mysticism: Sacred and Profane. London: Oxford University Press. Zeidner, M. & Beit-Hallahmi, B. (1988). Sex, ethnic, and social class differences in parareligious beliefs among Israeli adolescents. Journal of Social Psychology, 128, 333-343. Received 8 November 1991; revised version received 4 February 1992
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0 1992 The British Psychological Society
Mysticism and psychosis: The fate of Ben Zoma David Greenberg*, Eliezer Witztum and Jacob T. Buchbinder Jerusalem Mental Health Center, POB 35300, Jerusalem 91351, Israel
This paper examines the link between psychosis and mystical study through the cases of four young men who ‘entered the garden ’ of Jewish mystical speculation and subsequently became psychotic. The role of such study as a precipitating factor is suggested, as three had no signs of disturbance prior to their mystical studies. All had suffered personal losses, and their choice of mystical texts and rites showed that their attraction to mysticism included a search for atonement for guilt they felt over their loss. The features of normative mysticism are presented with each case and it is apparent that hallucinations, grandiose and paranoid delusions, and social withdrawal, are phenomena that do not distinguish the psychotic from the mystic. Diagnosis of psychosis is made on the basis of duration of the state, ability to control entry into the state and the associated deterioration of habits, particularly the neglect of daily religious duties. These findings emphasize the need for the examining psychiatrist to be aware of the cultural background, despite the presence of seemingly florid psychopathology. Four eminent Rabbis entered the garden of mystical speculation. Ben Azzai glimpsed and died. Ben Zoma glimpsed and was damaged (lost his sanity). Elisha ben Avuyah lost his faith. Rabbi Akiva departed in peace. (from Babylonian Talmud Hagiga 14b)
In the above Talmudic quotation, mystical speculation is seen to be dangerous for one’s physical and psychological welfare. Only one of the four rabbis was not adversely affected, and Ben Zoma became mentally ill (Ostow, 1988; Scholem, 1960). One section of the central Jewish mystical text, the Book of Splendour (Zohar), tells of three students who died during mystical ecstatic states. Mystics commonly hid their writings from the general population, and Jewish religious authorities, aware of the dangers, declared that mystical texts should only be studied by people who were stable in all areas of their lives: aged over 40, married and having thoroughly studied all basic Jewish texts for many years (Scholem, 1961). Mystical studies and experiences have dangers for the individual and the community. For the individual, the risks would seem to arise from the absorption in the unseeable and unprovable, the entry into ecstatic states, including seeing visions, and the loss of boundaries, which test the person’s link with his daily duties and realities (Ariel, 1988 ; Schneiderman, 1981). The structure of authority within the * Requests for reprints.
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community is also threatened, as the mystic achieves a closeness to God that may not be experienced by religious leaders (Scholem, 1967). Furthermore, the veracity of any claimed revelation is unprovable, a problem that faced religious leaders at the time of the pseudo-messiah Sabbatai Sevi (Scholem, 1973). The challenge to authority led rabbis to rule that rabbinic authority always overrides mystical experience. The relationship between mysticism and religion is seen to be complex the mystical experience is perceived as a deepening of normal religious life yet also destabilizing. William James (1982), in his pioneering study of religious experiences, noted that mystical states have several characteristic features : they cannot be adequately described or appreciated (ineffable), and there is a sense of revelation of knowledge hitherto unknown (noesis). These features create a divide between the mystic and the onlooker: does society react with acceptance or doubt? Is the mystic normal or abnormal ? The authors present four cases of young men who left secular lives to become ultra-orthodox Jews (known as ‘religious penitents’). In the course of their change, they immersed themselves in intensive mystical study and eventually became psychotic. The cases are viewed in order to examine the following issues: ~
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Does mystical study precipitate mental illness or does it appeal to the mentally unstable whose attraction to mysticism is part of their psychotic withdrawal ? What is the effect of local religious attitudes towards mysticism on the development of psychopathology? How do religions distinguish between the mystic and the psychotic?
Mysticism and psychopathology It has often been noted that the more central the role of culture-specific beliefs and behaviours in a society, the less likely they are to be associated with severe psychopathology (Leff, 1988). If having visions is normative, then it is unlikely to be a feature of psychotic illness (Kroll & Bachrach, 1982), and the converse is also true. So too with mysticism. Mystical experience is a central feature of Buddhism - the term Buddha means ‘enlightened one’, referring to the crucial mystical experience of its founder, Siddharta Gautama; while in Hinduism the seminal text, the Bhagavadgita, contains a mystical vision. Both religions contain meditation in everyday life and the mystic is an unremarkable member of society. This is not so in the modern Near Eastern religions. While mystical experiences are valued in Christianity, Judaism and Islam, they ;re treated with caution. The founders are reported as having had mystical revelatory experiences, but the religions emphasize rituals and social codes. While prayer is central in all three, none include meditation nor encourage attaining mystical experiences. Muslim authorities were concerned that novice mystics would suffer excessive elation and despair arising out of the mystical states of ‘expansion’ and ‘contraction’, and Quashayri, an 11th-century mystic, described expansion as ‘the greatest danger’ (quoted in Zaehner, 1961). The Christian authority most aware of the danger of mystical states was St John of the Cross, a 16th-century mystic, who described the intense depression experienced by the mystic yearning for union with God, a state he termed ‘the dark night of the
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soul’ (1973). In an analysis of the lives of prominent Christian mystics such as St Catherine of Genoa, St Teresa and Mme Guyon, Leuba (1925) concluded that they suffered hysterical episodes. It is the similarity between mystical and psychotic states, however, that has received most attention, as social withdrawal, delusions, hallucinations and strange behaviour are common to both (Buckley, 1981 ; Sedman & Hopkinson, 1966a, b). Features considered specific to mystical states are often found in psychosis : noesis may be experienced at the onset of psychosis (Bowers & Freedman, 1966; Buckley, 1981), so too unio mystica, the sense of mystical union with God prominent in Christian mysticism (Dupre, 1989 ; Fenichel, 1946). Certain features have been thought to differentiate between the mystic and the psychotic state. Although these observations are based on impression alone, they are presented for contrast with the ensuing cases. (I) Hallucinations are common to both ; while psychotic hallucinations are predominantly auditory, mystical hallucinations are commonly visual and their content is usually elderly people, who are benevolent counsellors (Arieti, 1976). (2) Glossolalia, or speaking in tongues, noted in mystical states in Christian revivalist groups, is distinguishable from psychotic thought disorder in that the former is incomprehensible, representing a language unknown to the speaker (Littlewood & Lipsedge, 1989). (3) The choice of words used by the psychotic and the mystic differs significantly. While the mystic tends to describe his experience using terms such as God, Christ, peace, soul and spirit, the psychotic’s description uses terms of illness and deviance (Oxman, Rosenberg, Schnurr, Tucker & Gala, 1988). This claim, however, was based on reports written by patients after their psychosis, and is in contrast to earlier reports, in which this distinction was not apparent (Bowers & Freedman, 1966). (4) Delusions of personal grandeur and omnipotence may be features of paranoid psychosis. They are unusual in the mystic, who views himself as a privileged vessel who must negate his own importance and not give way to self-flattery. (5) The affective responses may also differentiate the two: the mystic experiences ‘joy and sweetness’ or ecstasy (Buckley & Galanter, 1979; Wulff, 1991), while the psychotic may be terrified or indifferent to his psychotic experience. Bowers & Freedman (1966) noted that ecstasy was often present initially, and was then replaced by dread. (6) The mystical experience is transient (usually hours) and resolves completely, while psychotic states may last months or years, and will often leave residual delusions, flattening of affect or reduced social functioning. (7) Finally, the withdrawal of the mystic has been described as ‘facultative rather than obligatory’ (Group for the Advancement of Psychiatry, p. 784). Unlike the isolated psychotic, the mystic desires to share his experience with fellow mystics (Group for the Advancement of Psychiatry, 1976). While brief duration and absence of deterioration may distinguish mystical states from schizophrenia, this distinction does not apply to schizophreniform disorders, leading Buckley (1981) to speculate that both mystics and sufferers of brief psychotic episodes may be responding to ecstatic affective changes. Similarly, Lukoff (1985) has claimed that some psychotics are undergoing predominantly religious
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experiences ; they should be spared medication and instead helped to grow spiritually through their experience. While appealing, the view of psychosis as a lunge for health is not novel (Laing, 1965) yet remains undemonstrated.
Mysticism in Judaism Although the mystical tradition was widespread among Jewish communities, it has been most consistently accepted and studied among Oriental Jewish (Sephardi) communities. The main mystical text, the Book of Splendour (Zohur), is read daily in communal services and at all celebrations, and groups of young men are encouraged to study it regularly in Sephardi communities, in contrast to the restrictive attitudes in the Ashkenazi (European) communities described in the introduction (Chouraqui, 1975 ; Stahl, 1980). Jewish mysticism may be divided into two themes: theosophy and theurgy (Idel, 1988). In the theosophic element, the Jewish mystical lore known as kabbalah discusses such concepts as how and why God created the world, the principles and means for God’s ongoing maintenance and control of the creation, and the inner meanings of religious rituals. In addition, there is a body of practices known as folk kabbalah, which at a sophisticated level is concerned with theurgy, i.e. influencing God’s actions in the world, bringing redemption and overcoming evil, but which also flourishes at the personal level of cursing enemies, healing ills and wearing good luck charms (Hillel, 1990; Trachtenberg, 1974). The following cases are presented to identify specific areas of mystical study and practice that may consume the mentally ill patient, and confuse the assessing psychiatrist. In each case, the biographical and phenomenological details are presented, followed by an account of the relevant features of Jewish mysticism.
Case presentations Case 1 : PersecutoT hallucinations or demons 1 A 28-year-old of North African origin, born in France, married with two children, unemployed, began compulsory army service as an electrician and rose to the rank of staff-sergeant. His brother went missing during military action when the patient was 13. When aged 25, he converted to ultra-orthodox Judaism, and began visiting cemeteries throughout Israel in search of his brother’s lost tomb. His brother often ‘appeared’ before him and told him where to look. Whenever he located a site, he would light candles and remain there for the night conversing with his brother in order to ‘repair and elevate his brother’s soul’. A year later, he joined a fringe hasidic sect, and a few months later he was introduced to his wife and married. When his wife became pregnant, his brother appeared and told him that a son would be born, and he would be given the brother’s name. When, instead, a daughter was born, he refused to see her o r refer to her, and left home. He believed the birth of a daughter to be a punishment for his sexual activities, particularly masturbation, during the years before he became religious. An angel appeared to him, threatening to break his bones. He believed his situation to be ‘beyond repair’ (see Case 2). O n examination, he was unkempt, bowed over with his eyes fixed on the ground. He appeared
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depressed, barely replied, and his rare responses were brief and mumbled. He reported auditory and visual hallucinations : his brother appeared and told him not to take medication, and a band of angels also visited, including his personal angel who beat him. His rabbi ordered him to visit the tomb of the Jewish mystic, Rabbi Shimon bar Yochai, and he became slightly calmer. He was then taken to the tomb in Russia of Rabbi Nachman of Bratslav, founder of the sect he had joined. He has not returned to the clinic and his rabbi has informed us that he is largely unimproved two years later. Diagnosis. Depressed mood, concern with guilt and punishment and moodcongruent hallucinations, which are second-person throughout, are indicative of major affective disorder with psychotic features, while the paranoid content of the psychosis, the predominance of the withdrawal into psychosis and the chronic deterioration are consistent with paranoid schizophrenia.
Mystical background. Demons and evil spirits are an unquestioned component in the Talmud (3rd-5th century), and subsequently mystical works accorded demons a role in the cosmic design, representing the left side of creation, ‘the other side ’, or the force of evil, as opposed to the side of right and holiness. The Zohar states that demons are created by improper sexual relations and that demons arousing a man’s passions at night cause nocturnal emissions, whereby more demons are created from the spilt seed (Trachtenberg, 1974). During our clinical work we have noted that masturbation, regarded in Jewish religious literature as the ‘defect in man’s covenant with God’, and other sexual activity carried out prior to conversion to ultra-orthodox Judaism trouble our patients greatly after conversion and they are particularly frightened by the demonological consequences. The patient’s nocturnal visits to cemeteries in search of his brother were given a culturally acceptable form when his rabbi told him to visit the tombs of eminent mystics. The hasidic group he had joined encouraged such visits, as its founder, Rabbi Nachman, had visited the tombs of mystics to invoke their prayers on behalf of the Jewish people (Green, 1981). The concern with continuing his father’s name is consistent with the importance attached to names in the mystical tradition: the name of revered ancestors is given to descendants, while if a person is dangerously ill, his name is permanently changed. ‘His name is the mainspring not only of a person’s character, but also of his fate’ (Trachtenberg, 1974, p. 78). Case 2: Delusions of grandeur or ‘ Repairing the world’
A 26-year-old, unemployed man, recently married, ultra-orthodox for the past year was reported by his wife as behaving strangely over the last four months, had ceased studying and barely spoke. Of Sephardi Bulgarian stock, he completed school and army service without problems, but then immersed himself in the study of cults, such as Iman, and in the philosophy of the occult, such as the writings of Gurdjieff. A year previously he had converted to ultra-orthodox Judaism, and immediately ‘entered the garden ’ of mystical study. His behaviour changed : he would sit on the floor and
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cry over trifling matters, he visited cemeteries around Jerusalem with invisible companions in order to study kabbalah, and complained that the soul of a dead friend had transmigrated into his body, saying: ‘I have been impregnated by a spirit’. He undertook the ‘repair of spirits of the sinful who had died’ and to this end he pronounced the ineffable names of God and carried out prayers of unification with God, which he had collected from books on folk kabbalah. He became depressed and introverted, withdrew from all social contact, and began to wash his hands repeatedly until his skin bled. He was distressed when he lay on his bed at night and heard cries that asked him to repair dead souls. O n examination he was unkempt, avoided eye contact and stared at the floor. He was depressed and sighed despairingly. His answers were brief and sporadic, and he said that the sorrow he could express was but a part of what he felt over his failure to repair souls. He was deluded and hallucinated, stating that he studied kabbalah with the prophet Elijah and heard the cries of the spirits calling for his aid. He received a low dose of neuroleptic medication, and was advised by his rabbi to stop studying kabbalah. He became calmer, tidier, said that the cries had become softer and he could no longer make out what they were saying. He was less perturbed by the demons created by the sexual excesses of others, although concerned by the masturbatory errors of his own earlier ways. His hand-washing decreased and his relationship with his wife improved. He refused to increase the dose and dropped out of treatment. His wife understood his situation as follows : he was neither strong spiritually nor did he know kabbalah sufficiently, so that he failed in his mission and ‘fell’. Diagnosis. The same issues that were discussed in the first case are pertinent here: depressed mood, concern with sin and failure, and mood-congruent delusions and second-person hallucinations are suggestive of major affective disorder with psychotic features, while the chronic psychotic withdrawal and persecutory delusions and the partial effect of medication are indicative of paranoid schizophrenia.
Mystical background. Transmigration of souls from one body to another is an ancient concept, known in Sanskrit as ‘samsara’. Its use in early kabbalistic texts was limited to the transfer of the soul of a dead body to a live one as a punishment or in order to make retribution for sins, mainly sexual. The concept, known in kabbalah as ‘gilgul’, was broadened by the 16th-century mystic, Isaac Luria, to include the opportunity for all souls to g o back and complete their tasks on earth, known as ‘tikkun’ (repair) (Scholem, 1961). The books of Luria’s pupils are still studied today. Tikkun was a metaphysical concept developed by Luria, describing ‘the process of cosmic restoration and reintegration ’ (Scholem, 1961). Later, however, the term gained a more popular meaning: it is related that the souls of the dead who were suspended, neither able to enter paradise nor transmigrate, would come in droves to the Baal Shem Tov (‘the Master of the Good Name’, 18th-century founder of hasidism) and beg him to ‘repair’ them so that they could find their eternal rest in paradise. He succeeded in ‘ repairing’ their souls, presumably through prayer or magical means (Dov Baer ben Samuel, 1970).
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Case 3 :Halhcinations or revelations and personal angelJ A 24-year-old unemployed man who had converted to ultra-orthodox Judaism two years previously, married with a baby daughter had, six months prior to referral, begun to devote himself exclusively to kabbalistic study, particularly the Zohar and two works by Vital, pupil of Luria, the Book of Visions and the Book of Transmigrations. Following his daughter’s birth, he was disappointed, isolated and depressed. He said that he heard voices, and spent his time fasting, lighting candles and in imposed silence without changing his clothes. Of north African descent, he described his father as an alcoholic, who was often violent at home. When he was 15, he found his father dead after an alcoholic stupor. At the time, he blamed himself, was depressed and became addicted to opiates. When he became ultra-orthodox, he ceased all drug abuse, married, and when his wife became pregnant he hoped for a son to name after his father (see Case 2). Following his daughter’s birth, he started hearing voices that told him that, while every man has a personal angel, his angel’s task was to punish him for his father’s death; it instructed him to fast by eating no more than the size of an olive of food. He began to visit the tombs of Jewish mystics, where he would light candles and remain for hours. O n examination, he was unkempt, depressed, partially oriented and not fully cooperative. He barely answered questions, although he said that he had sinned and did not deserve to live. He reported hearing his angel’s voice by day and saw his father dressed in black in dreams. He received a low dose of a neuroleptic and was asked to write a letter to his father in which he asked him for forgiveness and permission to carry on living. His therapists and the patient’s brother, himself a Rabbi, explained to him that grief after the year of mourning is a contravention of Jewish law. During the next week he wrote his father a frank and moving letter, telling him of his personal angel and his fear that the angel would turn him by transmigration into a stone following his death. In order to understand the symbolic significance of his angel, and to bring it under mystical control, he was asked to cooperate in establishing the true identity of his angel : was he for the patient’s benefit or was he a demon? He told the therapists that he was able to summon his angel by lighting 12 candles and reading from the mystical text The Book of the Angel Raxiel and he did so during a therapeutic session. He gradually improved (see Witztum, Buchbinder & Van der Hart, 1990). Diagnosis. Depressive mood, guilt feelings, withdrawal, second-person persecutory mood-congruent hallucinations indicative of major depressive disorder with delusional features.
Mystical background. There is an intrinsic conflict between the concept of an abstract formless God and the existence of mystical-revelatory experiences. Nevertheless, even Maimonides, the 12th-century philosopher and codifier of Jewish law, himself a critic of mysticism, recognized a hierarchy of revelatory experiences: Moses as a prophet and the revelation o n Mount Sinai; other Biblical prophets; the holy spirit of the late Biblical period; the divine voice (‘bat-kol’) revealed to rabbis of the Talmudic era ;finally, experiencing the prophet Elijah. Kabbalists added a lower level
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of ‘the divine strength dressed as a man’. It is notable that this table of decreasing levels of revelation is also chronological, in keeping with the tendency to view the present generation as less holy and more sinful than its predecessors. Kabbalists were content to experience Elijah’s presence, to hear but a voice, without expecting to see a vision of light. They did not break the accepted code of the hierarchy of revelation, and did not report meeting or speaking with God. Instead they reported experiencing angels, and later still, they described the phenomenon of the Maggid. Early mystical literature relates the biblical reference to the ‘image of God’ in the creation of man to the existence of a personal angel, by means of which God controls every man’s life; God creates man’s image twice: one is the man, the second is his angel (Trachtenberg, 1974). A Maggid is an angel or superior being that reveals itself to a kabbalist in order to reveal secrets of the Creation through the media of a heard voice, automatic speech o r automatic writing. Common during the 16th-18th centuries, the most famous example was Rabbi Joseph Karo (Werblowsky, 1977), whose colossal academic achievements, and stable social and family status suggest he was not mentally ill (Lewis, 1978).
Case 4 :Psychotic behaviour o r theurgy A 23-year-old single man, religious penitent for four years, complained of worsening concentration, sleep and appetite as he was disturbed by voices that gave him instructions. Of Iranian origins, he was an unruly child, although he successfully completed his matriculation. He served in the army as a parachute instructor, and witnessed the death of a close friend in a terrorist border ambush. He became depressed and irritable and at that time he became increasingly interested in Bratslav Hasidism and aged 21 he began studying in a Bratslav academy (Witztum, Greenberg & Buchbinder, 1990). Shortly before referral, he started having a recurrent nightmare: soldiers on patrol fall one by one, including his dead friend. The patient also falls and is lifted on to a stretcher. O n examination he was neatly dressed. He appeared depressed, spoke in a monotone and with an air of despair. He described hearing voices which instructed him to kill himself and others. He received a low dose of neuroleptic medication. At his second visit he disclosed the following: For some months, he and a friend had been studying Jewish mystical texts, including the Zohar and works by Vital such as the Book of Visions and the Book of Transmigrations. After reading the section in the Zohar interpreting the Biblical text : ‘When you g o out to wage war with your enemy ’ (Deuteronomy, 21 :10) as dealing with the Satanic forces, the two decided that they too would go to war against the forces of evil, and attempt to hasten the redemption. Trained as a scribe, he wrote out God’s name on parchment as dictated by the Zohar, one text written in the shape of a sword. The pair intended using these amulets to call up the Lord and Lady of the ‘other side’, Samael and Lilith, in order to destroy them. O n the night appointed for the ‘battle’, the two friends recited the devotional prayers and went to sleep in a state of tense anticipation. A frightening vision appeared before him: pursued by a figure of fire surrounded by flames, he tried to wake up; a second vision followed: a column of men dressed in ancient bizarre clothing, some blind, others totally bald. All stood and stared. Then came the figure of fire, shouting : ‘You thought to destroy me ; it is I who will destroy you ! ’ ‘The
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sword’, he added with a groan while telling his story, ‘it was double-edged’. Since then, demons have pursued him day and night. Their form is constant: blind, hairless, ugly and hatted, telling him to kill others and himself, that they will make him mad and that he will go to hell. His partner suffered similar visions, became psychotic and was hospitalized. Leading kabbalists whom they consulted around the country were appalled that the two had attempted what great Rabbis had not dared and they offered no advice, except an ancient remedy of fasting for which he felt too weak. He explains what befell himself and his friend as what happens to the weak ‘who glimpse and are damaged’ (the Talmudic description of Ben Zoma’s fate). ‘The vessel was too weak to handle so much light; it cracked and was then smashed to smithereens ’. Diagnosis. Depressed mood, sleep and appetite changes, mood-congruent hallucinations, which gave him instructions, good recovery, suggestive of schizoaffective disorder. His psychotic partner in study was the more active of the duo, but the continuation of our case’s symptoms for months after the two friends separated rules out ‘folie P deux’. Mystical background. In Judaism, God is perceived as an absolute unity, and supernatural forces and creatures of evil are subject to God’s dominion (Short, 1982). The problem of the creation and existence of evil in the world is an important theme in Jewish mystical writings : evil is a necessity without which there would be no free will for choosing the good path. In kabbalah, the realm of evil, called the ‘other side ’, is distinct from holiness, yet is produced by God. Acts to call upon God and destroy the forces of evil are described in the lives of mystics and particularly hasidic leaders (Buber, 1947), although discouraged in the general population by religious authorities (Hillel, 1990). The salutary account of a Jewish mystic who used theurgic practices to bring about the redemption was related of Joseph de la Reyna, a 15th-century kabbalist. He was said to have taken five pupils into the desert, where they purified themselves. Using mystical acts, they summoned the Lords of Demons, Samael and Lilith, in the form of black dogs. They tied the couple up, but, in a moment of weakness, Joseph allowed them to sniff a grain of frankincense he was holding, they untied themselves and disappeared. The account ends that Joseph was punished and lost his faith (Benayahu, 1972 ; Scholem, 1933). The use of amulets containing parchment with written texts including the names of God and protecting angels has been popular since medieval times in protecting against the forces of evil. They are commonly requested at times when ‘Satan accuses ’ such as birth, circumcision, illness, a long journey or the death and burial of a close relative.
Discussion Four cases are presented of young men who began to study Jewish mysticism and became severely psychiatrically disordered. Aged between 23 and 28, all males, they were born in non-religious homes. In three cases, there was no apparent family psychiatric history, although collateral information was scant as the patient was brought by fellow penitents or rabbis who had not known them prior to their change
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to ultra-orthodoxy. With the exception of drug abuse in one case, their teenage years had apparently been uneventful and they had successfully completed army service, including promotion to officer status, reflecting a superior level of functioning. It is not uncommon for psychiatric disorders to emerge during the stresses of military service, so it is noteworthy that this did not occur. The clinical picture in all four cases was severe: vivid visual and auditory hallucinations, paranoid delusions, social withdrawal, and in the last three cases there was a marked deterioration of habits, with neglect of hygiene, clothing, and a cessation of the basic practices of Judaism and of religious study. Three cases received low doses of neuroleptic medication, with improvement in the interest they took in their surroundings, hygiene and religious practices. Hallucinations persisted, which may be due to the low doses of medication. It is possible that they refused to increase their medication and its effects as they were deeply drawn to their hallucinatory experiences. Similarly, their wives, fellow students and rabbis often continued to ascribe a sanctity to them. In our experience, however, while rabbis may have initially related to the experiences as mystical, once they perceived the prolonged duration of the withdrawal and the cessation of regular religious practice, they became convinced that the state was pathological, and they were committed to the need for psychiatric treatment. Does mystical study precipitate mental illness or does it appeal to the mentally unstable whose attraction to mysticism is part of their psychotic withdrawal ? It is remarkable that three patients reported the deaths of close friends or family, and the fourth referred to the soul of a dead close friend. In one case, mystical study followed immediately after the death, and in three cases the mental deterioration followed subsequent marriage o r childbirth. Two cases expressed overt guilt at the deaths (case 4 considers his friend may have been killed in the ambush by his own bullet). The conceptual explanations of Jewish mysticism for death and sin were of immediate appeal to our tortured patients : their sins created demons, their behaviour and repentance could alter the course of events. They changed concepts into concrete forms, and the guilt in their pathological grief was symbolized by devils (from past sins) trying to kill them, and drove them to the tombs of mystics. Their recent religious penitence may well have been an attempt to atone, and the birth of their first daughter instead of a first son, who is a gift to God in the Jewish religion (Exodus 13:2), is experienced as a lost opportunity for further repentance and proof of their unworthiness. Aberbach (1987) noted many similarities between grief and mystical states : depression, searching for the hidden one, withdrawal and detachment, visions of union, and identification with the dead (or God), and, finding that most mystics had suffered early losses of their parents, he suggested that ‘loss may be an important, even crucial, factor inclining an individual to mystical withdrawal’ (p. 510), and that ‘mystical union is a transcendent expression of grief’ (p. 515). Three cases became increasingly orthodox gradually, and their mystical study was a late component of this religious development. It appears that this process was simultaneous with their incipient psychosis, and their mystical state reflected their increasingly spiritual and decreasingly pragmatic concerns. The remaining case turned to mystical study at a time of crisis after the death of a friend. Considering their problem-free army service, it seems that our patients all had unresolved grief responses which were reactivated by the message of kabbalah that
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the souls of the dead not only live on, but can be repaired by man’s intervention. In this way, it may be that an interest in kabbalah may precipitate or aggravate psychosis. The increasing interest in the occult in the last decades has brought many young men to study kabbalah in Jewish religious institutes of study. Therefore, many study kabbalah, and only a few are referred for help. It is noteworthy that most of Jerusalem’s institutes for religious study are situated in our catchment area, including institutes for religious penitents. A recent clinic sample did find more mental illness among religious penitents (Witztum, Greenberg & Dasberg, 1990). A prospective study comparing the rate of mental illness in students of kabbalah and other matched controls would be necessary to ascertain if students of mysticism are more likely to develop psychiatric problems. Premorbid testing would establish if unstable people are attracted to the subject. Only the unlikely design of random allocation to mystical or non-mystical studies would demonstrate the effect of mystical study alone. What is the effect of local religious attitudes towards mysticism o n the development of psychopathology ? All four cases came from Sephardi homes : two from North Africa, one from Iran and one from Bulgaria. In Ashkenazi communities, mystical study is discouraged and restricted, and Ashkenazi Jews are often ignorant of its role in Judaism. In Sephardi communities, these restrictions d o not exist, and the major mystical texts have a respected role in everyday life. Similarly the practice of folk kabbalah, such as the wearing of amulets and turning to folk healers at a time of illness are more accepted within the Sephardi community, religious and secular. Superstitious beliefs such as tempting the devil, transmigration of souls, possession, fortune telling, evil eye, amulets, lucky numbers and walking under ladders are more commonly held by Sephardi than Ashkenazi adolescents and these beliefs increase during adolescence (Zeidner & Beit-Hallahmi, 1988). We conclude that the attraction that mystical study and practices hold for Sephardi religious penitent referrals in our report reflects the familiar place of the Zohar and mystical beliefs in Sephardi society. The religious penitent Sephardi Jew is more drawn to the study and practice of kabbalah than his non-penitent born-religious Sephardi counterpart. This may reflect the enhanced yearning of the spiritual seeker who comes to religion as an adult in contrast to the more habitualized practice of the born-religious. Alternatively, the intense mystical pursuit of the religious penitent may merely reflect a new avenue for those suffering from a long-standing psychopathological process. Ongoing studies aim to gain a deeper understanding of the life histories, conversion process and subsequent religious direction of mysticpatients and non-patient Sephardi religious penitents. How d o religions distinguish between the mystic and the psychotic ? We have learned that mystical texts and their study are an integral part of the Jewish religion. They are seen as a means for the committed Jew to gain greater understanding of the essence of God as he appears to mankind through creation and revelation. The great Jewish mystics have included eminent Rabbis, famed for their knowledge and observance of the ritual aspects of Judaism (Werblowsky, 1977). It is clear, therefore, that an absorption in mystical study per se may be acceptable and respected behaviour within the Jewish community. In contrast, the deterioration of habits, particularly the neglect of religious ritual
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in our patients, was an indicator of disturbance. Related aspects of Jewish mysticism were presented after each case, and these demonstrated that the terminology and behaviours of our patients were products of their studies. So much so, that in two of the cases teachers of mysticism continued to give them advice, e.g. fasts and visits to tombs were prescribed as appropriate responses to their sorrows until advanced stages of their conditions. The symbols and language that they used were typical of mystics and may well have been learned and expressed in the same terms as their fellow students. Reflecting its integrated social status in Sephardi society, mystical texts are taught by a sage in groups. The provision of guidance and the practice of learning in groups and pairs serve to create a framework that establishes the study as normative, support its members and control the content. The isolation and independent study of our patients were early signs of disturbance. Although amulets are commonly worn in Israel, the active use of magic (folk kabbalah) is expressly forbidden by rabbis: ‘Demons start up only with those who start up with them, such as by writing amulets, practising sorcery o r asking dream questions. Therefore one should not engage in these practises ’ (Sefer C h i d i m 469, quoted in Hillel, 1990, p. 47). The patient who dabbled in magic did so without guidance. O u r study supports the observations of Murphy (1967) : the content of delusions and hallucinations may not differ from cultural norms. All of our cases developed delusions and hallucinations, apparently bizarre and pathological. Perusal of the concepts and practices of Jewish mysticism reveals that their thoughts of demons, angels, etc., were acceptable within the sects that they had joined (delusory cultural beliefs). The pathognomonic features were the accessory details : neglect of their other studies and practices, study in isolation and without guidance, and the suspect practice of folk kabbalah.
Acknowledgement The authors wish to thank the Latner Foundation for their continuing support for this project.
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