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Illness and Cures

By Rabbi Dr. Hillel ben David (Greg Killian)

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The Ramchal[1] teaches that the world was not created perfect. It had an imperfection, but only in potential. It is a mistake to think that the world was created perfect. We think that HaShem[2] is perfect, therefore His creation is perfect. This is not true. The world we see is imperfect according to our standard, how much more according to HaShem’s standard! The world was created with an imperfection, i.e. it was created with a distance from HaShem. We can see natural disasters, human and animal suffering, and even plants are far from perfect. They all have imperfections. This world is full of limitations; it is not infinite. The plants, animals, and men all have limitations. One would expect that since HaShem is infinite, His world would be infinite.[3]

 

If Adam,[4] upon awakening, had realized how far he was from HaShem; if he had been aware of this distance, he would have fulfilled his obligation of exile forever! When he was placed in that garden[5] he should have had a sense of the tragedy that he had been created and was no longer part of the Creator. If he had felt that distance he would have immediately returned to HaShem. Instead, he manifested the human tendency to say, “Hmmm, this is not bad”. This world is not so bad, according to his perception. This tendency required ‘exile’ in order to be excised from the human psyche.[6] That is why the current exile is so bad. Consider how often we wake up and consider that our own world is ‘not so bad’. If this is our perception of a sinful world, then how much more did Adam perceive that his world was ‘not so bad’!

 

If you ask whether this world was created with a degree of suffering; the answer is ‘No’! With our attitude, we have forced the world to have a greater degree of suffering. Because we take the changes to the world wrought by our sins; and we say ‘it is not so bad’. We force HaShem to step up His game, so to speak. To deepen the exile and bring greater suffering to bring us to the realization of just how far we are from HaShem.

 

The world was created with an imperfection, i.e. it was a created entity and was created with a distance from The Creator. For example, if Adam chose to use his free will incorrectly he could bring death and destruction to the world, which he did! He brought the world with potential for death, he brought that potential into the actual. If Adam had realized the potential of the world, in this regard, and had used his free will to negate all the possibilities of suffering, then we could have avoided going through all of this.

 

Consider that a child can learn to trust his mother, who commands him not to touch the hot stove. Or he can touch the hot stove, get burnt, and learn the hard way that he should have trusted his mother’s word. She created the danger by cooking on the stove, but the child had two ways to deal with this potential problem: He could do what his mother commanded, or he could touch the hot stove, suffer the burning pain, and then learn not to touch hot stoves. Thus the child, like Adam, brought the potential for suffering into the world in actuality.

 

HaShem made the world like a glass sculpture. He did not create the broken pieces that resulted from your carelessness in dropping that sculpture. He did create it as fragile, as a world capable of being broken. HaShem gave us a fragile world and He gave us the task of handling it properly. We need to use our free will to choose the correct path. Unfortunately, we don’t always choose wisely. Thus we can accuse HaShem of creating a fragile world, but we cannot accuse Him of breaking it with all of the accompanying problems. We broke His world.

 

If you go back to the beginning, you will find that HaShem created an idyllic world without death and illness, but man chose to break that idyllic world and bring death and suffering into the world. Man created death and suffering, so to speak. Our merit, however, is that HaShem gives us the ability to fix our crashed world. The Talmud[7] has a passage where Chazal express gratefulness that HaShem created a fragile world because otherwise we would not be here, and we would not have the ability to fix it, and thus acquire merit.

 

The world was created with the potential for imperfection, and ever since that first sin it has continued to break down. This includes suffering, even suffering we cannot understand.

 

Why can’t we understand why suffering and illness come into the world? We need to understand that we live in a phase of history where HaShem hides His face.[8] The reason for this is that we have moved very far from the beginnings at Sinai, and very far from the source of His “voltage”. The voltage has dropped considerably. Each generation adds to the sins of the world and each generation contributes to the darkening of the world. We are in the post-prophecy phase. This is the age where there is no prophecy or prophets. In the phase where we had prophecy, one could go to the prophet and he would tell you the spiritual reason for your sickness. Once you corrected the underlying spiritual problem, the phyical manifestation of that problem was also corrected. While a doctor could see symptoms that could be adjusted, he could never see the underlying spiritual cause.

 

In those days we had the book of cures. The Talmud[9] teaches about King Chizkiyahu[10] hiding away “The Book of Cures – Sefer HaRefuot”. The remedies written down in that book could heal anything and the chance of getting healed was extremely high or almost 100%. It is unknown who wrote it. Some people claim that it was Shlomo HaMelech.[11] The Talmud,[12] however, teaches us that King Chizkiyahu decided to hide the book. Why? Wouldn’t such a book be great because it would enable everyone to get healed? There are actually different opinions on why King Chizkiyahu hid the book away. For instance, Rashi says that Chizkiyahu wanted the Jews to rely on G-d and pray to Him when they are sick. People got so used to relying on the book and getting healed that they forgot thanking G-d afterwards. One of the intended consequences of an illness is to give us a sense of our own vulnerability.

 

Sickness for our benefit

 

Originally, death came without warning. One sneezed[13] and we died. The infirmities of old age were given to highlight our vulnerability for a very special reason. This vulnerability causes us to start preparing for our own demise. It gives us a warning to get our spiritual house in order, knowing that our end is near. This is a legacy of our Patriarchs who prayed that we should have old age and infirmities so that we would be warned that our end is approaching.[14] This warning gave us time to correct our faults and perform teshuva.[15] This is a precious gift!

 

Note that even when we had old age, infirmities, and sickness, in those days, of the first phase, we still had the book of cures. But, to go back to answer our question:  Why can’t we understand why suffering and illness come into the world? The answer is we can never know, now, because we no longer have access to prophets. Living in this phase where HaShem hides his face is specifically designed so that we will not know why things happen the way they do. It is a tragic error to go to modern mystics who claim to know such things. Even if they know, they are not to be trusted because we are not to know. Our Hakhamim[16] are not given this specific knowledge, they are only given generalities.

 

There are some rare individuals who are given direct knowledge about why things happen to them. But, this is a special occurrence that is very rare.

 

Today, when we are sick we go to the doctor. A doctor does not have the book of cures and he certainly does not know the underlying spiritual condition that needs to be corrected. Never the less, HaShem uses doctors to bring about His desire and His treatment. The doctor merely disguises HaShem’s hand so that HaShem’s face will remain hidden. We function in the darkness. The great blessing of functioning in the darkness is that we are less responsible for correcting the errors. As we move away from HaShem the darkness intensifies and we become less responsible. This is analogous to working with the low voltage of a battery where mistakes have minimal consequence. Now the first phase would be analogous to using high tension voltage where the slightest mistake will get you fried. That is why, in Jewish history, every time man made a mistake with HaShem’s Torah, HaShem took a step back and became more hidden in order to protect us from the consequences of our mistakes. The tragedy is that we live in the darkness and we don’t know how to correct specific spiritual illnesses to correct the resulting physical illness, and we are very far from HaShem.

 

So, if a person gets ill, what should he be doing? The normative Torah requirement is that we do whatever is considered ‘normal’. So, if the question is:  How many locks should I have on my door? The answer is: Whatever is considered normal in that area. In a big city, normal might include a deadbolt, a locking knob, and a chain. In the country they may not even use a lock. Clearly locks offer no protection if HaShem is bringing us trouble, and no locks are needed if HaShem is guarding our door. The locks, whatever they may be, simply disguise HaShem’s hand. If we use more than the normal amount of locks it is considered a lack of faith. Somehow you perceive that one more lock will protect you. If we use fewer that the normal number of locks it is considered irresponsible. In the same way, we should do whatever is considered normal, in our location, for any illness.

 

When we are sick we should undertake to get the normal healing; what ever is wide spread in your time and place. It does not matter if it is considered an alternative form of medicine; once it becomes accepted on a wide spread basis, that is the route we should pursue. And the reason, as we stated before, is that HaShem heals us and the medical treatment merely hides His hand. Our headache is not cured by the aspirin tablet, it is cured by the hand of HaShem and the aspirin is just a cover-up. One of the basic facts of life is that Hashem runs this world. While it may appear that man is in charge, HaShem orchestrates every activity on the planet. The question is: What is man’s part? If HaShem determines all outcomes, how is man supposed to act?

 

Chovot HaLevavot[17] teaches us that we are obligated to act b’derech hatevah – in the ways of the world. In other words, we are obligated to go through the motions as if the results are dependent upon us, knowing all the while that the outcome is completely out of our hands, and is in the hands of HaShem.

 

We work for a living, knowing the amount of money we are to make has been set on Rosh HaShanah.[18] We go to doctors when we are sick, even though we know our health is determined solely by HaShem. We put in our effort, knowing all the while it is HaShem’s world and He alone determines the outcome.

 

One does not need to scour the world looking for a cure. If the illness is rare and it can only be found in a distant place, they we must do what is considered normal and travel to that place. On the other hand, if there is an accepted treatment at hand, then we should use that treatment. Can we spend a fortune and travel the world looking for an exotic cure if we wish to? The answer is:  It depends. In general, making excess effort is a lack of faith, just like putting too many locks on your door. Conversely, you must at least do what is ‘normal’, if we do otherwise we have not done what HaShem requires of us.

 

Now, everyone knows that medical treatment is constantly changing. What is accepted today will certainly change tomorrow. Never the less, we are to seek the treatment that is considered normal for our time and place. This begs an interesting question:  What if the normal treatment causes a person harm? For example, what if the medicine has severe side effects? The answer is that we seek the normal treatment and if it causes us harm, then HaShem intended for us to have that side effect. And, He does it for our benefit! In effect, we needed that harm.

 

This does not mean we ignore extenuating circumstances! For example:  If a vaccine is suspected of cause one of your children to be autistic, then one must consider that the treatment, while normal, is abnormal for your family. That is why a child would not be circumcised on the eight day IF his brother died, or had serious consequences from a prior circumcision. Remember that the mitzvot were meant to bring life, not death:

 

Vayikra (Leviticus) 18:5 Ye shall therefore keep my statutes, and my judgments: which if a man do, he shall live in them: I am HaShem.

 

This plays out in another circumstance:  Suppose that the normal treatment is very ineffective. Are you obligated to try it anyway? The answer is no; we are obligated to the normal cure If it is reasonably effective. For those cures which are not effective, there is no obligation to use an ineffective cure, and there is no penalty if you do decide to use it. After all, if HaShem brings the cure He can bring it no matter how ineffective the treatment might be. This ineffective treatment is allowed if there is no other hope and all alternatives have already been explored.

 

The same applies to experimental treatments. If all the research has been done, due care has been exercised, and the situation is dire, then we can engage experimental treatment, but there is no obligation to engage that treatment.

 

I read in a computer journal about a woman who had twin daughters who were two years old when they were diagnosed with Niemann Pick Type C[19] disease. This disease kills before you are old enough to go to school and produces severe brain problems like Alzheimer’s disease.[20] The disease is caused by a build-up of cholesterol[21] in the brain. She heard about a treatment, for rats, that uses a type of sugar[22] that removes cholesterol from the bodies of rats. Because the twins were in a bad way, our Hakhamim would have given permission to use this experimentally to treat Niemann Pick disease.

 

If the treatment has no evidence that it will cure, yet it has evidence that it will not harm, then one may engage the treatment, but there is no obligation.

 

If you are on an exceptional level in your emunah, your faithfulness, then there are some who say you can make less than the normal effort. However, these would be the exceptional people.

 

There are many limitations to the knowledge of medical doctors. For example, doctors have no idea why your fingernails keep growing, but your fingers do not. No one knows why the body reaches a certain level of development and then it just stops. This should be sufficient for one to trust HaShem and not a doctor, even though we should seek his treatment.

 

Before the flood, people lived hundreds of years. After the flood, man’s lifetime was greatly decreased. In the Messianic age men will again live hundreds of years. A person who dies at 700 years of age will be called a ‘lad’, a young boy. There is no medical reason why we should not be able to live hundreds of years today. No one knows why we have this limitation. Some turtles, for example, live hundreds of years today.

 

Given our life time limitation, our Hakhamim have decreed that we are not allowed to harm ourselves, therefore smoking is forbidden. For example, the thought of a physician assisting a patient to commit suicide is anathema to a Jewish view of medicine. Physicians (and for that matter, anyone else with medical knowledge such as nurses, emergency medical technicians, or lifeguards) are granted a mandate to heal. However, it is unequivocally clear from halacha[23] that permission is granted to a physician to treat a patient only when he can offer that patient therapy that can be reasonably expected to be efficacious. This, at times, may include even experimental treatments that could be helpful.

 

When a physician cannot offer effective therapy, cannot alleviate pain, and cannot cure the patient, he or she ceases to function as a physician. In such a case, he or she has no more of a license than anyone else to cause harm to another person. Physician-assisted suicide is wrong because it undermines the mandate that the Torah grants to physicians to be G-d’s partners in the treatment of the sick.

 

On the other hand, one might also ask:  If HaShem made you sick, what right do you have to go get a cure?

 

There actually is a great deal of controversy in Jewish halachic literature as to where we derive the mandate to heal. While most authorities derive a very broad mandate, there are a few very famous minority opinions that severely limit the scope of the authorization to provide medical care.

 

The most obvious source to look for the authority to heal would be from the case of two men fighting in:

 

Shemot (Exodus) 21:18-19 If one man strikes another and the victim does not die,[24] “[the aggressor] shall pay for his [lost] time [from work] and he shall cause [the victim] to be thoroughly healed.”

 

Rashi, the great Biblical commentator, learns that this passage instructs us that “he shall pay the fee of the physician.” Clearly, if the aggressor is commanded to pay the doctor’s bills, then seeking medical treatment and providing medical treatment must be not only permissible, but also obligatory.

 

Not so, writes the Ibn Ezra,[25] another great Biblical commentator. The command to heal “is a sign that permission has been granted to physicians to heal blows and wounds that are externally visible. But, all internal illnesses are in G-d’s hand to heal”.

 

Why does the Ibn Ezra take a limited view of the mandate to heal? Are we indeed in agreement with the Christian scientists who teach that all healing comes from G-d, to the exclusion of human medical intervention? The Ibn Ezra’s case is not a hard one to make. The Torah itself instructs that if we listen carefully to the mitzvot of the Torah:

 

Shemot (Exodus) 15:26 26 and He said: ‘If thou wilt diligently hearken to the voice of HaShem thy G-d, and wilt do that which is right in His eyes, and wilt give ear to His commandments, and keep all His statutes, I will put none of the diseases upon thee, which I have put upon the Egyptians; for I am HaShem that healeth thee.’

 

This verse implies that G-d does not need man to cure the afflictions that He creates. The Ibn Ezra argues that the meaning of this Torah passage is that because G-d acts as the (sole) healer of all illness, we will not need physicians. If this is the case, is it not a lack of faith that would lead us to seek medical care?

 

If Ibn Ezra is correct, by what virtue does man attempt to “short circuit” G-d’s will and attempt his own meager cures? Does man have any right to heal at all, and if he does, are there any limitations on how it may be accomplished? Is every action done in the name of therapy justified, solely because a physician performs it?

 

Because Judaism recognizes the enormity of these questions, it requires direct permission from G-d to permit the practice of medicine and carefully circumscribes the limits of medical practice. The duty to save one’s fellow man is well grounded in the Torah and the restrictions are discussed at length in our codes of Jewish law.

 

The complexity of the previously mentioned philosophical tension between G-d’s control of health and the role of the human healer is encapsulated by the enigmatic opening words of the Code of Jewish Law’s discussion of the laws applying to physicians: “The Torah gives permission to the physician to heal; moreover, this is a mitzva[26] and it is included in the mitzva of saving a life; and, if he withholds his services, he is considered a shedder of blood”.

 

This sentence is rather puzzling. We do not find the Code of Jewish Law informing us that the Torah gives permission to keep kosher, the Sabbath, or any of the other mitzvot enumerated in the Torah. Why is permission specifically granted here? Because only here we may have thought that the action should be forbidden. Left to our own logic, we would have no choice but to assume that G-d makes people sick and G-d alone heals.

 

So, are the Christian scientists[27] correct? No, they are not. Once the Torah clearly stated that healing is permitted, it immediately becomes a mitzva,  like all other mitzvot. Therefore, the Code of Jewish Law quite appropriately states that “The Torah gives permission to the physician to heal; moreover, this is a mitzva”.[28]

 

Chazal teach that we are forbidden to rely ONLY on prayer for our healing. Once the Torah permits using a doctor, at that point we MUST use a doctor!

 

So what part does prayer play in dealing with an illness? Chazal teach that we must be a bit schizophrenic in the handling of illness. On the one hand, we must realize that there is no cure except by HaShem’s hand, and therefore we pray like nothing else will bring a cure, or perhaps it is better to say that we should pray that the doctor will cure us; while at the same time we must put our full effort into seeking a physician and completely following their recommendation. In essence, we must pray that the medicine we are about to take should provide a cure, knowing full well that it is HaShem who will use that medicine to hide the fact that He provided the cure and the medicine was worthless except by His command it becomes efficacious.

 

To a certain extent, this schizophrenic attitude should accompany every action and every thought in all areas of life. For example, we must understand that HaShem provides our living and everything is determined on Rosh HaShana, while at the same time putting our heart and soul into earning a living.

 

What is the Jewish approach to the physician? There is a fascinating insight about King Asa[29] when he became ill. The Bible records that:

 

Divrei HaYamim (II Chronicles) 16:12 And in the thirty and ninth year of his reign Asa was diseased in his feet; his disease was exceeding great; yet in his disease he sought not to HaShem, but to the physicians.

 

If healing and guarding health are mitzvot, what did King Asa do wrong? His error was that he only sought out the doctors. Healing is a partnership between G-d and a man. While G-d is the ultimate healer, He delegates part of His role to mankind and asks the physician to practice medicine for the good of man. This relationship can be conceived of as follows: G-d makes a person ill until he finds the right doctor to heal him.

 

That is, part of the “punishment” of illness is the fear that one will not find the right physician capable of healing him. This is why the Code of Jewish Law states: “if he withholds his services, he is considered a shedder of blood. And even if there is someone else (available) capable of healing, not every physician is able to heal every patient”.[30]

 

Medicine is an art and therefore one must pray that he finds the right doctor who can cure him. Similarly, no physician may excuse himself from a case merely because there is another physician present, for he may be the one destined to cure this patient (i.e. he may be the one who will make the right diagnosis and prescribe appropriate treatment when all others are baffled or incorrect). This approach must obviously exist within the reality of the physical limitations of each physician.

 

The Jewish approach to illness and medicine requires us to recognize the preeminent role of G-d in healing, while seeking appropriate medical care. Asa’s sin was seeking out the doctors only, without the recognition of G-d as the ultimate healer.

 

The Talmud[31] states: “the best of the doctors are bound for hell”. Such a statement appears antithetical to the positive view Judaism promulgates regarding physicians. One traditional explanation is that the physician must recognize the awesome responsibility that he holds in treating illness, with even a small error possibly leading to death. Constant vigilance is required to avoid making a preventable error that would be considered bordering on criminal negligence.

 

A second understanding of this mysterious passage sheds light on one of the great risks of medical practice, arrogance. The statement can be understood to mean that it the specifically those doctors who consider themselves to be the best that are bound for Gehenom. The humble physician will realize his limitations and consult with colleagues, bringing the best care to his patients. The “best” doctor will see no need to consult with those less qualified than himself, eventually causing unnecessary harm to a patient for which he will be culpable.

 

Like the patient, the physician must have the same recognition of his role as an intermediary in healing, not its source. When the physician begins seeing himself as the source of healing, he is destined for Gehenom.[32]

 

 

* * *

 

This study was written by

Rabbi Dr. Hillel ben David (Greg Killian).

Comments may be submitted to:

 

Rabbi Dr. Greg Killian

4544 Highline Drive SE

Olympia, WA 98501

 

Internet address:  gkilli@aol.com

Web page:  http://www.betemunah.org/

 

(360) 918-2905

 

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Send comments to Greg Killian at his email address: gkilli@aol.com

 



[1] Moshe Chaim Luzatto 1707 in Padua, also known by the Hebrew acronym RaMCHaL (or RaMHaL, רמח”ל), was a prominent Italian Jewish rabbi, kabbalist, and philosopher.

[2] In Judaism, HaShem (lit. " the name") is used to refer to God, when avoiding God's more formal title, Adonai (lit. " My Master").

[3] This study is based on a shiur given by Rabbi Akiva Tatz.

[4] Adam is a figure from the Book of Genesis who is also mentioned in the Nazarean Codicil.  According to the creation account in the Torah, he was the first human.

[5] The Garden of Eden

[6] Psyche is the Greek term for "soul" or "spirit".

[7] Menachoth 53a

[8] Hester panim (הֶסְתֵר פָּנִים)

[9] Berachot 10b

[10] Chizkiyahu - Hezekiah

[11] King Solomon

[12] Berachoth 10b

[13] Just as the neshama, the soul, was blown into Adam by his nose, so also did it depart by his nose. Although not technically part of Jewish Law (halachah), saying gezuntheit or G‑d bless you is considered a mannerly custom. It is written in the Midrash that the Patriarch Jacob was the first person to become ill before passing on. Before that, people would sneeze and die. When G‑d infused the soul into Man, He "blew it" into Adam's nostrils. Thus, when it came time for the soul to be returned to its Maker, it would leave through the same portal it arrived.

[14] Genesis Rabbah 65:9.1

[15] Repentance

[16] Hakhamim mean “wise One” is the name given to Sephardic Rabbis.

[17] Duties of the Heart is the primary work of the Jewish philosopher and Rabbi Bachya ibn Paquda, full name Bachya ben Joseph ibn Pakuda. Ibn Paquda is believed to have lived in Zaragoza, Spain in the first half of the eleventh century.

[18] The Biblical new year.

[19] Niemann-Pick Disease is one of a group of lysosomal storage diseases that affect metabolism and that are caused by genetic mutations.

[20] Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior.

[21] Cholesterol is a waxy substance that comes from two sources: your body and food. Your body, and especially your liver, makes all the cholesterol you need and circulates it through the blood. But cholesterol is also found in foods from animal sources, such as meat, poultry and full-fat dairy products. Your liver produces more cholesterol when you eat a diet high in saturated and trans fats.

[22] (2-Hydroxypropyl)-β-cyclodextrin

[23] The word "halachah" is usually translated as "Jewish Law," although a more literal (and more appropriate) translation might be "the path that one walks." The word is derived from the Hebrew root Hei-Lamed-Kaf, meaning to go, to walk or to travel.

[24] Which might make it a capital crime.

[25] Rabbi Abraham Ben Meir Ibn Ezra (1089–1167) was born in Tudela, Navarre in 1089, and died c. 1167, apparently in Calahorra. He was one of the most distinguished Jewish poets and philosophers of the Middle Ages.

[26] A religious obligation.

[27] Christian Science is a set of beliefs and practices belonging to the metaphysical family of new religious movements. It was developed in 19th-century New England by Mary Baker Eddy, who argued in her book Science and Health (1875) that sickness is an illusion that can be corrected by prayer alone.

[28] Yoreh Deah 336: 1

[29] Asa was, according to the Hebrew Bible, the third king of the Kingdom of Judah and the fifth king of the House of David. He was the son of Abijam, grandson of Rehoboam, and great-grandson of Solomon. The Hebrew Bible gives the period of his reign as 41 years. His reign is dated between 913-910 BC to 873-869 BC. He was succeeded by Jehoshaphat, his son (by Azubah). According to Thiele's chronology, when Asa became very ill, he made Jehoshaphat coregent. Asa died two years into the coregency.

[30] Yoreh Deah 336: 1

[31] Kiddushin 82b. Babylonian Talmud.

[32] Gehenna (/ɡɪˈhɛnə/; Ancient Greek: γέεννα), from the Hebrew Gehinnom (Rabbinical: גהנום/גהנם), is the Jewish analogue of hell or purgatory in Christianity. The terms are derived from a place outside ancient Jerusalem known in the Hebrew Bible as the Valley of the Son of Hinnom (Hebrew: גֵיא בֶן־הִנֹּם or גיא בן-הינום, Gai Ben-Hinnom). The Valley of Hinnom is the modern name for the valley surrounding Jerusalem's Old City, including Mount Zion, from the west and south. It meets and merges with the Kidron Valley, the other principal valley around the Old City, near the southeastern corner of the city.