Soul,body and mental health – applying Rabbi Moshe de Maimon’s philosophy to the contemporary phenomenon of drug addiction

Drug addiction: aetiology and current models

The term ‘addiction’ has its roots in the Latin word addictus (from addicere) which denotes ‘slave due to default debt’. Addicere is a Latin compound of dicere and the proposition ad, from which the English word ‘addiction’ is directly derived, meaning literally ‘to speak to’ and, more loosely, to ‘assent’ or ‘adjudge’ (Rosenthal and Faris, 2019). The modern definition of addiction is a ‘persistent compulsive use of a substance known by the user to be harmful’. Research has shown that addiction is a disease that chemically alters the brain, making the sufferer ‘a slave’ to a substance or activity (Baconi et al., 2015).

Drug addiction and substance use disorders (SUD) are severe, relapsing and persistent psychiatric or mental conditions, which adversely affect the health and social functioning of sufferers, and are a major burden on their families and wider society (Schulte and Hser, 2014). Addiction can be regarded as a complex disease process of the brain that results from recurring drug intoxication and is modulated by genetic, developmental, environmental and experiential factors (Goldstein and Volkow, 2002).

In the modern scientific literature, various models of addiction have been proposed, including: the brain disease model (Leshner, 1997; Pickard, 2022), the neurobiological model (Popescu, Marian, Drăgoi and Costea, 2021), neurophysiological underpinnings (Herman and Roberto, 2015) and psychological theory (Wanigaratne, 2006). Also, the biopsychosocial model of addiction states that genetic/biological, psychological and socio-cultural factors contribute to substance consumption and should be taken into account for its prevention and treatment (Skewes and González, 2013). From the neurocognitive perspective (Noel, Brevers and Bechara, 2013), addiction is widely associated with impairments in cognition and perception, including processes of attention, reasoning and decision-making (Goldstein et al., 2009; Gould, 2010; Lee, Hoppenbrouwers and Franken, 2019; Ramey and Regier, 2019; Rochat, Maurage, Heeren and Billieux, 2019; Verdejo-Garcia, Garcia-Fernandez and Dom, 2022). Emotional deficits have also been reported (Estévez et al., 2017). The literature cited clearly emphasizes the complexity of drug addiction.

In this paper, I will introduce additional models of drug addictions, from a Jewish philosophical-theological perspective. I will start with the concept of God in Guide for the Perplexed, and then discuss the human soul with reference to the Maimonides’ treatise The Eight Chapters (Shemona Perakim).

God in Judaism – a brief overview

In Judaism, throughout history from ancient to modern times, God has been conceived in a variety of ways. Traditionally, Judaism holds that Hashem – the God of Abraham, Isaac and Jacob and the national god of the Israelites – delivered the Israelites from slavery in Egypt, and gave them the Law of Moses at Mount Sinai as described in the Torah (Ballentine, 2022). Jews believe in a monotheistic conception of God (God is the only one), which is both transcendent (wholly independent of, and removed from, the material universe) and immanent (involved in the material universe) (Lebens, 2020). God is portrayed as unique and perfect, free from all faults, deficiencies and defects, and is held to be omnipotent, omnipresent, omniscient, and completely infinite in all of his attributes; he has no partner or equal, being the sole creator of everything in existence (Lebens, 2022). The names of God used most often in the Hebrew Bible are Hashem and Elohim. Other names of God in traditional Judaism include El-Elyon, El Shaddai and Shekhinah.

God according to Maimonides – ‘Zelem’ Elohim

Rabbi Moshe Ben Maimon (aka Moses Maimonides), also known by the acronym ‘Rambam’, was born on 14 Nissan 4898 in Cordova, Spain. He was a very influential philosopher, theologian and physician, and he wrote numerous renowned philosophical, ethical and medical treatises and books (Mizrahi, 2011). One of his most important philosophical-religious works in Jewish thought is the Moreh Ha-Nevuchim (Guide for the Perplexed). Another book by him that is pertinent to our discussion is the Shemona Perakim (The Eight Chapters), which is an introduction to the Tractate of the Fathers, and its focus is the unity of the human soul.

I shall begin by looking at some specific passages concerning the concept of God in the Guide for the Perplexed (Arabic: Dalālat al-ḥā'irīn). Maimonides wrote this book in the twelfth century in Classical Arabic using the Hebrew alphabet. It was first translated into Hebrew in 1204 by the medieval philosopher, Samuel ibn Tibbon. This book ¹ begins with Maimonides’ thesis of the unity, omnipresence and incorporeality of God, explaining biblical anthropomorphism of divine attributes as homonymous or figurative. The first chapter explains the Genesis I description of Adam, the first man created in the ‘image of God’. Maimonides begins with a discussion of the term ‘zelem’ (image). Some thought that the Hebrew zelem meant the shape and figure of a thing, and this explanation led men to believe in the corporeality (of the Divine Being). They thought that the words ‘let us make man in our zelem’ (Genesis I:26) implied that God had the form of a human being, that He had a figure and shape and that consequently He was corporeal (i.e. has a physical body) (Gottstein, 1994).

In the Hebrew Bible, the word zelem has two similar meanings. One refers to an ‘idol’, as can be seen in the following example from the Second Book of Kings:

Then all the people of the land went to the house of Baal and tore it down; his altars and his images they broke in pieces, and they killed Mattan the priest of Baal before the altars. And the priest posted watchmen over the house of the Lord. (Kings 2, 11:18)

The second meaning is a more metaphorical way of describing a tangible item, and that is how we understand the other meaning of ‘image’, which can be found in the Book of Genesis. Maimonides maintains that the essential characteristics of God are: God exists; God is one; God is incorporeal; God has intelligence; God creates; and God governs. Humans possess the following characteristics: humans exist; humans have the capacity to be intelligent; in the sense that creativity is the ability to transform something into something else that never existed before, humans have the capacity to create; humans have the capacity to govern. Humans, as opposed to God however, are corporeal. When Maimonides uses the word ‘image’, the meaning is the likeness of man, or resemblance to God, to God’s essence. The God of Maimonides is not a person. Man does not resemble God in the physical sense, nor do we attribute human qualities to God. If we were to accept the view that ‘zelem’ implied that God had the form of a human being and thus was corporeal, it would mean that we attribute to God qualities of imperfection. According to Maimonides, God is incorporeal and at the most has Logos. ² The resemblance to God, being ‘like’ God, within Maimonides’ philosophy refers to possession of divine wisdom and intellect, which is the essence of God. Man should strive to obtain knowledge of God and to follow God’s path; this includes being a virtuous person, doing good deeds and valuing one’s own life and the lives of others, and also observing the Mitzvot (commandments).

God, being all perfect and intelligent, could not have created an imperfect and badly designed world. Hence, addiction cannot be conceptualized as imperfection of any kind. God created a perfect and intelligent world, and gave people free choice. We must assume that the addicted individual chose this way of life, despite the negative consequences.

Drug addiction is a vicious cycle in which the addicted man (i.e. human being) finds himself ‘imprisoned’, lost, lonely and perplexed. This person has reached the point where he no longer appreciates life, or the value of self-existence. It is possible that, prior to becoming addicted, the person was observant and benevolent and appreciated life. Nonetheless, due to some life-course events, he made a choice. So, addictive behaviour can be regarded as straying from God’s path. In my view, if God created man in his image, it implies that all men were created equally virtuous, in possession of the divine intellect and wisdom. It could be argued that, for the addicted person, alienation from God was necessary in order to obtain independent self-existence and autonomy. The individual may have been so devoted in his faith that he became addicted to God (theodiction) (Chira, 2013), until excessive reliance on God became ‘toxic’ (Taylor, 2002) and he then sought his independence. In this case, ‘positive addiction’ resulted in a ‘negative addiction’.

Chapter 1. The soul and its faculties

Maimonides opens the first chapter of the book by elucidating the nature of the soul and its faculties; by faculties he means ‘activities’. The soul is one, but it has multiple functions or activities. Every individual possesses various faculties, but it does not mean he has several identities (Mizrahi, 2011): ‘Know that the human soul is one. It has many diversified activities. Some of these activities have been called souls, which has given rise to the opinion that man has many souls’ (Maimonides, 1912: 37, original emphasis). Maimonides continues: ‘Thou knowest that the improvement of the moral qualities is brought about by the healing of the soul and its activities’ (p. 38).

In the above passage, Maimonides attests that the improvement (tikkun) of our character traits (middot) is brought about by curing the soul (refuat ha nefesh). Moral behaviour is the ethical key to the healing of the soul, and healing of the soul equals healing of the body. Maimonides is talking about moral perfection, the highest degree of excellence in a person’s character. What is morality? Broadly speaking, morality or virtue ethics is human behaviour that shows high moral standards: doing what is right and avoiding what is wrong. Derived from the Latin ‘virtus’ (the personification of which was the deity Virtus), the word had connotations of ‘manliness’, ‘honour’, worthiness of deferential respect, and civic duty as both a citizen and a soldier. It is a disposition that is deeply rooted in its possessor – something that ‘goes all the way down’, unlike a habit such as being a tea-drinker; the person notices, expects, values, feels, desires, chooses, acts and reacts in certain characteristic ways. To possess a virtue is to be a certain sort of person with a certain complex mindset.

Although the soul is one, Maimonides divides it into five parts: nutritive soul (Ha-Zan), perceptive (Ha-Margish), imaginative (Ha-Medammeh) and appetitive (Ha-Mit'orer) and the rational (Ha-Maskil). I will now discuss each of these faculties or ‘powers’ and will try to understand their relevance to human behaviour and specifically, addictive behaviour. In relation to the nutritive faculty of the soul, Maimonides writes:

Let me say that the nutritive faculty consists of (1) the power of attracting nourishment to the body, (2) the retention of the same, (3) its digestion (assimilation), (4) the repulsion of superfluities, (5) growth, (6) procreation, and (7) the differentiation of the nutritive juices that are necessary for sustenance from those which are to be expelled. (p. 40)

So, the nutritive part of the soul is responsible for nourishment. It has a physiological function and controls the physiological systems of the human body. Ramban says that the nutritive ‘soul’ of an animal differs from the nutritive ‘soul’ of man. An animal can see, hear, smell and perceive objects in nature, just like man. However, a human soul differs from the animal’s as it also possesses an additional quality of higher intelligence, and an ability to grasp reality at a higher level of perception.

The faculty of perception consists of the five well-known senses of seeing, hearing, tasting, smelling, and feeling, the last of which is found over the whole surface of the body, and is not confined to any special part, as are the other four faculties. The imagination is the faculty which retains impressions of things perceptible to the mind, after they have ceased to affect directly the senses which conceived them. This faculty, by combining some of these impressions and separating others from one another, thus constructs out of the originally perceived ideas, some of which it has never received, and which it could not possibly have perceived.

The appetitive faculty is the one by which a man desires or loathes a thing, and from which there arise the following activities: the pursuit of an object or flight from it, inclination and avoidance, anger and affection, fear and courage, cruelty and compassion, love and hate, and many other similar psychic qualities. All parts of the body are subservient to these activities, such as the ability of the hand to grasp, of the foot to walk, of the eye to see, and the heart to make one bold or timid. Similarly, the other parts of the body, whether external or internal, are instruments of the appetitive faculty.

The rational faculty is peculiar to man. Through reasoning, it enables him to understand, to reflect, to acquire knowledge of the sciences, and to discriminate between proper and improper actions. Its functions are partly practical (either mechanical or intellectual) and partly speculative (theoretical). By means of the speculative power, man knows things as they really are, and knows which, by their nature, are not subject to change.

With reference to addictive behaviour, the following parts of the soul are of interest: the nutritive soul, the appetitive soul and the rational soul. I will now present my interpretation of these faculties, in relation to addiction and whether a man is responsible for his choices. Superficially, the nutritive part of the soul is irrelevant to the discussion of addiction and substance use disorders. The phrase ‘What you eat is what you are’ means that it is important to eat good food in order to be healthy and fit. So, if drug addiction is an unhealthy condition – a sickness – then it must be because the man has ‘nourished’ his soul (voluntarily or involuntarily) with bad ‘ingredients’. For various reasons, the individual did not acquire the social-, cultural- and community-related ethical codes of behaviour (e.g. parental upbringing, environmental factors, experience of suffering and disappointment, maltreatment and abuse) (Garami et al., 2019; Kim et al., 2010); this possibly contributed to initiation of wrongful behaviour like excessive drug intake. It is true that a man decides what food enters the body and knows which supplements are good and bad, but in a real-life context, our emotions and desires do not always depend entirely on us. Human beings are social creatures, and if connectedness with other humans is denied, an individual deprived of this crucial ‘nourishment’ will probably feel alienated from society and will seek an alternative way to fill the inner void within his soul.

The appetitive part of the soul relates to the realm of feelings, emotions and desires. This part is connected to the body as well as the soul. The human being is an active agent who decides how he feels, and the internal emotional state (i.e. anxiety, fear) may affect the body (Noushad et al., 2021). The rational part of the soul is the ability to engage in metaphysical ideas. According to Maimonides’ view, the rational soul is ‘matter’ (Hebrew equivalent of ‘container’), which enables the appearance of ‘form’, that is reason or intelligence. Human wisdom is eternal and comes from heaven, from the knowledge of God (i.e. following God’s path and observing the commandments). The rational soul is divided into theoretical (also called ‘speculative’) and practical intelligence (intellectual). In other words, we possess active and passive intellect, and both are pertinent to the rational soul.

On the one hand, the content of our thoughts is not totally within our control, but on the other hand, we have the ability to choose how to learn and acquire knowledge. The extent of our potential – how much to learn and to what degree of expertise – depends on us. Here, Maimonides refers to the learning of the Torah. The ability to reason and to think adequately is, to some extent, impaired in an addicted person. It is not that the intellectual ability is absent or lost, but the addicted individual ceases temporarily to discriminate between the right or good way of life and the bad; when engaged in an addictive behaviour, he inflicts harm on himself, sometimes without realizing it.

Chapter 2. On transgressions and observances

In Chapter 2, Maimonides asks whether a human being has free choice. He is talking about the transgressions and observances of the Law, and to which faculties of the soul they belong. In chapter 1, he suggests that the man is responsible for all that the soul does, yet this is not really the case. Maimonides explains that the nutritive and the imaginative parts of the soul are ‘automatic’ or biological, and man has no voluntary control over their activities. Our ability to learn (the Torah) and obey the Law are moral actions, qualities specific to the sensitive/perceptive and appetitive ‘powers’ of the soul:

KNOW that transgressions and observances of the Law have their origin only in two of the faculties of the soul, namely, the sensitive and the appetitive, and that to these two faculties alone are to be ascribed all transgressions and observances. . . . The proof of this is that the functions of both these faculties, the nutritive and the imaginative, continue to be operative when one is asleep, which is not true of any other of the soul’s faculties. (Maimonides, 1912: 47)

Maimonides continues by discussing moral virtues and intellectual virtues, which each correspond to two classes of vices (the antitheses of the virtues):

Now, as for the virtues, they are of two kinds, moral and intellectual, with the corresponding two classes of vices. The intellectual virtues belong to the rational faculty. They are (1) wisdom, which is the knowledge of the direct and indirect causes of things based on a previous realization of the existence of those things, the causes of which have been investigated; (2) reason, consisting of (a) inborn, theoretical reason, that is, axioms, (b) the acquired intellect which we need not discuss here, and (c) sagacity and intellectual cleverness, which is the ability to perceive quickly, and to grasp an idea without delay, or in a very short time. The vices of this faculty are the antitheses or the opposites of these virtues. Moral virtues belong only to the appetitive faculty to which that of sensation in this connection is merely subservient. The virtues of this faculty are very numerous, being moderation [i.e. fear of sin], liberality, honesty, meekness, humility, contentedness, courage, [faithfulness], and other virtues akin to these. The vices of this faculty consist of a deficiency or of an exaggeration of these qualities (p. 49)

Maimonides says that the moral virtues (good qualities such as courage, truthfulness, love, respect, forgiveness, discipline and fear of God) are governed by the appetitive faculty (our emotions and individual personality traits, tendencies), and intellectual virtues are part of the rational faculty (wisdom, theoretical reasoning, logical thinking). The vices are the opposite of the virtues and tend to be on either side of an extremity; for example, over-anxious, too impulsive, or extravagant or having a deficiency (never fearless, too indifferent, etc.). On the face of it, one could say that, because of impaired cognitive functions in addiction (Sofuoglu, Sugarman and Carroll, 2010), it is a problem of the rational faculty, but it is not. Some form of thinking and reasoning is impaired in addiction, but the intellect Maimonides is referring to is not a learned quality but innate, divine, a ‘generic’ code that we can not change. Moral qualities (though not all) are acquired throughout life, and we learn to manipulate our tendencies accordingly, depending on the given situation. In the case of addiction, there is a failure to do this; external factors (social) interfering with personal traits (such as impulsiveness, being worried) lead the person to exercise his interior potential inadequately, thus submitting himself to psychological, emotional and physical harm.

Chapter 3. Sickness of the soul

This chapter discusses the sickness and health of the soul:

THE ancients maintained that the soul, like the body, is subject to good health and illness. The soul’s healthful state is due to its condition, and that of its faculties, by which it constantly does what is right, and performs what is proper, while the illness of the soul is occasioned by its condition, and that of its faculties, which results in its constantly doing wrong, and performing actions that are improper. The science of medicine investigates the health of the body. (Maimonides, 1912: 51)

In this passage, Maimonides maintains that sickness–health of the soul is a continuum depending on the relationship between the inner state of the soul (i.e. moral traits) and their external manifestation. This means that a healthy soul is defined by a harmonious relationship of traits and actions. The ‘ill’ soul is when a person is lacking moral qualities and commits bad or wrong actions. The sickness of the soul is also evident when the actions of the person are not genuine, and do not correspond naturally to his inner character. If the person is constantly struggling to conquer the ‘evil’ side so that he can engage in ethical behaviour, then this is still considered to be a sick soul. Health of the soul is obtained when good deeds are a way of life, for the most of the time. If the person is normally graceful and merciful, then the soul is healthy.

An individual addicted to drugs is situated in a ‘bubble’, a reality that he believes is the true reality for him. It is obvious that the faculties of the soul are not unified and do not perform adequately to achieve the main and only goal and essence of life: knowledge of God, in terms of following His path and being virtuous. All actions of the addicted person, as well as his thoughts and desires, are aimed at the object of indulgence, i.e. the consumption of the drug. Due to the addiction, the man does not see clearly that he is hurting himself and others, and will probably do illegal, immoral acts to satisfy his needs (stealing, cheating, lying). Addiction obscures his true identity. The bad actions are not because of a deficiency in moral traits, but due to the momentary external life circumstances. In the following chapter, Maimonides explains how the soul can be cured.

Chapter 4. Curing the soul

This chapter is devoted almost entirely to health issues. As Maimonides stated at the end of his third chapter, ⁴ the Torah enjoins us to care for our health, so here he elaborates on what he considers a healthy lifestyle. We will discuss the part of the chapter that deals with the virtues and vices and how the soul can be cured:

Good deeds are such as are equibalanced, maintaining the mean between two equally bad extremes, the too much and the too little. Virtues are psychic conditions and dispositions which are mid-way between two reprehensible extremes, one of which is characterized by an exaggeration, the other by a deficiency. Good deeds are the product of these dispositions. Liberality is the mean between sordidness and extravagance; courage, between recklessness and cowardice; dignity, between haughtiness and loutishness; humility, between arrogance and self-abasement; contentedness, between avarice and slothful indifference; and magnificence, between meanness and profusion. (p. 53)

The mean way (Golden Middle) is the ideal way. The individual needs to bring himself to a situation of self-control and to avoid any inclination to an extremity. In other words, with reference to addiction, for example, the individual should try not to be always hot-tempered (impulsive) or too calm, or desire things that only the body needs.

Maimonides postulates that the powers of the soul, the inner character of the man, must be in accordance with his actions. Good (moral) human qualities lead to good actions. Character traits (moral behaviour) can be learned, according to Maimonides. Mental health/cure of the soul lies in the improvement of morals, which will bring the human being to a mental and physical balance. Unity of all powers of the soul will prevail when a man strives to get to the one and only goal, that is, the knowledge of God and observance of the Torah. The far-reaching question is whether this kind of perfection can ever be obtained. Is addiction a societal problem, and therefore must society, the community, be responsible for treating addicted community members? Is it even a necessity that a man should be perfect? Such perfection might even be a burden. Moral perfection is also a problem. So we will forever face a tremendous rupture between all parts of our soul, never reaching the ‘true’ valid mental and physical homeostasis.

Unquestionably, addiction is a harmful condition, to the person and the whole society. It is not an ‘evil’ or bad deed per se, nor is it a sin. The addicted individual does not see reality for what it is. He believes he is healing himself through addiction and fails to understand the magnitude of the problem, so there is a need for social intervention. By virtue of compassion, non-stigmatization, understanding, and teaching of social-cultural and religious codes of comportment, society can contribute to the proper balance between the soul and body. Once the addicted person acknowledges that he has a problem and will see that life is worth living, he will be more willing to improve his conduct and make a shift in his worldview, and will regain faith in humanity and the divine.