Have Your Megillah and Pies, Too

November 13, 2014

For this psychiatrist, learning a section of the Talmud known as Megillah brought to light an important exchange that has implications in therapy and psychopharmacology, regardless of theoretical stance.

It is clear that without Ronald Pies, MD, an Editor-in-Chief Emeritus of Psychiatric Times, we would not have this wonderful forum for cutting-edge science advancing our specialty nor would we have a place to share thoughts and ideas that make our practices so richly meaningful.

Dr Pies has never shied away from relating Chazal’s philosophy (an acronym for the Rabbis from the Talmudic age that roughly translates to “our wise Rabbis, may their memory be a blessing”) to Rational Emotive and Cognitive Behavioral Therapy (REBT/CBT). Additionally, he has written books that point how the ethical texts of the Jewish tradition (without any emphasis on religious dogma) can guide everyone towards a life worth living. Humbly, I will try and write in his footsteps here.

Recently, I had the pleasure of learning a section of Talmud known as Megillah. While ostensibly this section provides an overview of the laws of the holiday or Purim-when the Megillah of Esther is read-as with all sections of the Talmud, it includes valuable digressions.

In one such digression, a series of Rabbis ask their teachers why they have merited to live to such an old age. R. Eleazar B. Shammua replied that he was rewarded with long life because he never made a shortcut through a synagogue, pushed people out of the way to get to his seat in the study hall, or lifted his hands without delivering a blessing.

[[{"type":"media","view_mode":"media_crop","fid":"29455","attributes":{"alt":"Talmud and psychiatry","class":"media-image","id":"media_crop_7384033912736","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3047","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","title":" ","typeof":"foaf:Image"}}]]Rabbi Peridah replied, “Never in my life have I allowed someone to arrive before me to the study hall.” R. Nehunia b. ha-Kaneh replied to his students “Never in my life have I sought respect through the degradation of my fellow.” R. Joshua b. Korha explained his reaching old age by saying, “Never in my life have I gazed at the countenance of a wicked man.”

None of these explanations seem, in a rational sense, to lead to a long life. While some of the responses do indicate personalities that would cause less interpersonal conflict and thereby reduce stress and possibly extend one’s life, this was not my initial understanding. When I initially came across these exchanges, I assumed that these men were meriting long life by seemingly small acts that were being divinely rewarded.

Fortunately my family and I were recently able to host Cantor Zev Muller at our table. In addition to being an internationally known Cantor who has performed at the United Nations, he is currently working towards his PhD in neuroscience at Columbia University. He explained that while my reading of the section of Talmud described above may not be wrong, he could explain it differently. “Howie, you focus on the explanations the Rabbis give, but I believe the focus should be on the word ‘never.’ What leads these Rabbis to live long lives was the consistency with which they applied the values they held to their own lives.”

Lessons learned
Although I had always recognized his intellectual prowess, Cantor Muller was able to explain the Talmudic exchange above in a rational sense squarely in the tradition of Pies’ “Talmudic lessons for all.” Furthermore, Cantor Muller touched on something that is important for our success as therapists, regardless of theoretical stance, and as psychopharmacologists. The consistency of our treatment and the fact that we are always there when we say we will be allow our therapy patients to gain consistency in one relationship that will hopefully generalize.

For our psychopharmacology patients, we need to impress upon them the necessity of always taking their medication, not just when they “feel sick.” What we talk about or the particular medication we prescribe is likely to be of far less consequence than the regularity with which each intervention takes place.

Although I do not believe there is anything we can do to ensure long life, the Rabbis in this Talmudic exchange are at least teaching exegetically the importance of consistency. As this is towards the beginning of what the Rabbis in the Talmud would have considered the New Year, may it be a year for all of us to improve not only our craft but the consistency with which we apply it.

Disclosures:

Dr Forman is Assistant Professor of Psychiatry, Albert Einstein College of Medicine, and Attending Psychiatrist, Montefiore Medical Center, Bronx, New York.