To the Editor: In their commentary published in the April 2008 issue of the Journal, Benjamin Gesundheit, M.D., Ph.D., et al. (1) are to be commended for their novel translation of a crucial document written by Maimonides and for bringing his ethical principles to the attention of modern readers. However, the authors’ introductory statement that alcohol was “the only available treatment for depression at the time” (1, p. 425) requires some clarification.
Maimonides, as stated by the authors, is widely recognized as one of the earliest proponents of what modern-day clinicians would call psychosomatic medicine. Less well known are his contributions to what we would now refer to as cognitive behavioral therapy (2–4). Maimonides implicitly recognized that grief, if carried to extremes, could lead to clinical depression and advised a kind of behavioral program to help “wean” the bereaved individual away from excessive mourning:
During the first three days, the mourner should think of himself as if a sword is resting upon his neck; from the third to the seventh day as if it is lying in the corner; thereafter, as if it is moving toward him in the street. Reflections of this nature will put him on his mettle, he will bestir himself [ Hilkhot Avel 13:12] (5)
This process bears a striking similarity to techniques of “guided imagery,” which is often used in the treatment of various phobic and posttraumatic disorders. Indeed, the fathers of modern-day cognitive behavioral therapy, including Aaron Beck, M.D., and the late Albert Ellis, Ph.D., may be considered the heirs of Maimonides’ pioneering ideas.
1.Gesundheit B, Or R, Gamliel C, Rosner F, Steinberg A: Treatment of depression by Maimonides (1138–1204): rabbi, physician, and philosopher. Am J Psychiatry 2008; 165:425–4282.Kranzler HN: Maimonides’ concept of mental health and mental illness, in Moses Maimonides: Physician, Scientist, and Philosopher. Edited by Rosner F, Kottek S. Northvale, NJ, Jason Aronson, 1993, pp 49–573.Bulka RP: Psychological formulations in the works of Maimonides, in Moses Maimonides: Physician, Scientist, and Philosopher. Edited by Rosner F, Kottek S. Northvale, NJ, Jason Aronson, 1993, pp 135–1434.Pies R: Maimonides and the origins of cognitive-behavioral therapy. J Cogn Psychother 1997; 11:21–365.Maimonides M, Halkin A: Crisis and Leadership: Epistles of Maimonides. Philadelphia, Jewish Publication Society, 1985, p 292
The author reports no competing interests.
This letter (doi: 10.1176/appi.ajp.2008.08040502) was accepted for publication in April 2008.