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         fear and melancholy can be encountered in every person from time to
         time, in different situations and at different times, because a person’s
         mood is constantly changing under the influence of his inner world
         and his external surroundings. Now, man is a wondrous creation
         different from all other creatures in both the heavenly spheres and
         in this world, in that he is a union of [disparate] parts hailing from
         two separate realms that are distant from one other: a coarse, physical
         body and a sublime, spiritual soul. Between these two extremities lies
         the lower soul [on which topic our teacher, the Vilna Gaon wrote a
         treatise on the seventy different powers within man]. Thus, in man
         three realms are united: the first is the physical realm, which includes
         the body with its 248 limbs and 365 sinews. The second realm is that
         of the soul where man is situated. The third is the spiritual realm
         where the lower level of the upper soul is situated and if there is some
         imbalance, mental illness results.”

            There is a kind of mental illness in which the disorder only ex-
         presses itself in one area while in all other respects the person behaves
         normally. For example, in the response of Chachmei Provence (1, 57)
         it is written, “The husband has been suffering from turmoil for the
         past two years, being constantly terrified by hallucinations, believing
         that there are people inside his abdomen who frighten him.” As a
         result he had stopped eating meat, drinking wine and sleeping in a
         bed “because in his thinking, meat and wine worsen his illness and
         when he sleeps on a bed he imagines that the people in his abdomen
         will frighten him, so he sleeps on the ground or on benches. His mind
         is only affected in this matter. Otherwise he asks and answers rele-
         vantly.” The poskim refer to this condition as “a shoteh in one respect.”
         Our teachers disagree over his halachic status. Tosfos in maseches
         Chagigah (3b, s.v. derech) write that he is considered a complete shoteh
         [i.e. in all matters]. The Tevuos Shor (Yoreh De’ah,1) explains Tos-
         fos’s intention as being that he requires checking, and if his mind
         is orderly in other respects, he is considered normal. The Tzemach
         Tzedek (Even Ha’ezer, 153) however writes that a shoteh in one respect
         is considered as being “normal at times and a shoteh at other times.” 
         Therefore, in considering our question the first issue to examine is

216  1  Medical-Halachic Responsa of Rav Zilberstein
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