Healing and Medicine: Healing and Medicine in Judaism
HEALING AND MEDICINE: HEALING AND MEDICINE IN JUDAISM
Jewish sacred texts, in particular the Hebrew Bible, Apocrypha (noncanonic, postbiblical writings), rabbinic literature from the late Roman era (the Talmud and midrash), the Mishnāh Torah (Repetition of the law; a twelfth-century ce classification of religious subjects), and the Shulhan Arukh (The prepared table; a sixteenth-century ce codebook of Jewish law), all touch upon sickness, recovery, and health. Excerpts on health from holy books and their influence on Jewish culture can be arranged readily into the following six subjects:
- divine healing,
- health wisdom,
- visiting the sick,
- religious law (halakhah),
- folk healing,
- professional medicine.
In the Bible (c. sixth century bce), God is the force responsible for both sickening and healing: "I deal death and give life; I wounded and I heal" (Dt. 32:39). Accordingly, God inflicts plagues, heals Hezekiah's intestinal ailment, and tests Job with boils and other misfortunes. The psalmist appeals directly for "rescue" and "deliverance" to God, who is "compassionate and gracious"; other biblical figures seek out God's prophets, as the woman of Shunem called on Elisha to revive her dead son (2 Kgs. 4:8). A certain skin disfigurement (tsaraʾat) is always a mark of divine disfavor (Lv. 13). Thus when Moses' sister Miriam contracts tsaraʾat, he cries out, "O God, pray heal her! [Eil na rʾfah na lah!] " (Nm. 12:13).
Jewish healing prayers follow a biblical model. Jeremiah is the source of the ancient prayer recited still in daily Jewish liturgy: "Heal us, O Lord, and we shall be healed" (Jer. 17:14). Psalms are recited daily for someone who is critically ill; the Mi SheBerakh (May the one who blessed) prayer is sung for "healing, courage, and faith" in front of the opened Torah; late-medieval Yiddish prayers (tekhines) written by Jewish mothers ask God for safe pregnancies and well children; and modern prayers—prayer writing continues to be a vital religious activity—request strength and calm, "healing of body and mind." A prayer's soothing effect comes not just from the words alone; just as important are davening (a Yiddish term meaning fervent recitation, often while standing and swaying), cadence, melody, chant, and the consoling context of the daily or Sabbath service liturgy, held in communion with clergy, family, and friends.
Except for prayer, Judaism has no required rite for restoring health, nor do the relics, saints, pilgrimages, or exorcisms that are features of other religious traditions. The Jerusalem Temple did not offer treatment directly, as did the contemporaneous healing temples of Aesklepios, even though sick people surely must have come there to offer petitionary and thanksgiving sacrifice. After the Temple was destroyed in 70 ce, the Talmud declared that there is no healing in shrines, perhaps referring to pagan or Christian sites but also precluding Jewish sacerdotal healing (Abodah Zarah 55a).
Jewish religious texts explicitly promote mental and physical health. They take their cue from the Book of Proverbs, which itself follows the more ancient tradition of "wisdom literature," a stream of aphorisms, poems, and fables that give pragmatic guidance on how to live long and successfully. "A man's spirit can sustain him through illness," Proverbs says, "but low spirits … who can bear them" (Prov. 18:14). The Proverbs -like Apocrypha text Ben Sira (Ecclesiasticus in the Jerusalem Bible) states, "Better a poor man healthy and fit than a rich man tormented in body" (Ben Sira 30:14), and it condemns gluttony and drunkenness. The Talmud encourages bathing and washing after meals, bodily cleanliness being inseparable from spiritual purity (Abodah Zarah 20a). The Mishneh Torah and the Shulhan Arukh have entire chapters on dietetics, exercise, rest, and sexual temperance, through which they elevate practical hygienic advice into religious obligation.
In the opinion of some scholars, dietary laws (kasrut) from Leviticus, assiduously followed by traditional Jews, were originally intended to promote healthiness. Moreover, they argue, dietary laws together with rules of Sabbath observance, pregnancy, menstruation, penile discharge, childbirth, excretion, cadavers, sexuality, and tsaraʾat constitute a program of public health. The Bible itself makes no such claim. Nevertheless, for millennia observant Jews have thought them to be rules of hygiene. Indeed, it has been said that because of hygienic practices, medieval Jewish populations avoided the worst ravages of bubonic plagues.
Visiting the Sick
Job's friends sat quietly with him for a week, until he was ready to speak. Ben Sira (second century bce) urges, "Do not shrink from visiting the sick" (Ben Sira 7:35). The Talmud (second–sixth centuries ce) made this ancient courtesy into a solemn commandment, grounded on the biblical story of the three messengers from God who came to visit Abraham after he was circumcised. Visiting the sick, the sages state with emphasis, is among the highest religious obligations, and visiting does indeed heal, especially "if they (the visitors) loved him like themselves" (Midrash Rabbah Leviticus 34:1). The Talmud declares, "He who visits the sick causes him to live," and he who does not is "a shedder of blood" (a murderer). Because the Divine Presence "rests above the invalid's bed," as he or she wavers between death and life, the sickroom is to be regarded as awesome and sacred. However, the visitor must not come when the sick person is indisposed, lest they be exhausted or humiliated (Nedarim 39a). Everyone, rich or poor, must visit the sick, especially if the illness has come on suddenly, and they should "pray for his recovery and depart" (Mishneh Torah 14:4:14). The Shulhan Arukh adds, "one must visit the sick of the Gentiles in the interest of peace" (Yorah Deah 335).
Few other commandments (mitsvot) shape Jewish culture as profoundly. Visiting is an imperative for family and friends and among the most important duties for a congregational rabbi. Autonomous visiting the sick (Bikkur Cholim) societies, synagogue volunteers, and hospital chaplains ensure that every sick person has company. Traditional rabbis shape their calls mindful of detailed visiting rules set forth in the Shulhan Arukh.
Religious Law (Halakhah)
Mainstream Jewish spiritual practice follows laws found in the Bible and the Talmud together with later refinements and corrections. What sets the precept to visit the sick apart is its therapeutic intent. Most rules concerning patients are excusatory; that is, they relieve the sick person of possibly harmful obligations, such as fasting on the Day of Atonement. Preserving or saving someone's life overrides any other duty. However, when life is not threatened, a broken bone, for instance, medical care might be put off. Centuries of rabbinical commentary (responsa) have dealt with other difficulties, like observing commandments during a plague, so there has been an substantial accumulation of legal precedents (medical halakhah ).
Moral dilemmas in contemporary medical care, notably surrounding abortion, euthanasia, genetic engineering, and prolongation of life, are stimulating interest in pertinent Jewish law. In 1959 Rabbi Immanuel Jacobovitz defined the subject and scope of modern Jewish medical ethics, and subsequently prominent rabbis and physicians have added casuistic (moral) analysis in numerous articles and books on the subject. The premises of Jewish medical ethics are that life is sacred and that all actions must be in accordance with morality in the Talmudic tradition. Ethicists distinguish the Jewish emphasis on the individual's moral obligations, especially to choose life, from the secular emphasis on the individual's autonomy, even to choose death. However, medical-ethical dilemmas are as contentious for Jewish ethicists as for their non-Jewish counterparts.
Throughout history, Judaism has had a rich tradition of healing folklore. Isaiah treated King Hezekiah for intestinal illness with an application of figs (Is. 38:21). According to ancient legend, King Solomon acquired knowledge of healing from God, then wrote a healing text, which was later followed by a school of Jewish folk practitioners (Josephus, Antiquities of the Jews, bk. 8, chap. 2). In addition, Solomon was said to be a sorcerer-astrologist who could banish illness demons (The Testament of Solomon). Folk belief also has it that the angel Rafael stands guard at night over the sickbed.
The Talmud devotes pages to materia medica that came from ancient Babylonia concerning the warding off of demons, the evil eye, and other causes of illness with charms, amulets, potions, and incantations. To cite one Talmudic remedy, "For migraine one should take a woodcock and cut its throat with a white zuz over the side of his head on which he has pain" (Gittin 69a). This, the rabbis knew, was magical, but they declared as principle that "nothing done for the purpose of healing is forbidden on grounds of superstition." By the Middle Ages, however, rabbis came to believe that Talmudic medicine was archaic and counseled their followers not to use it. Nevertheless, it is still published.
According to stories in the Talmud (aggadah), certain rabbis were healers. "Give me your hand," said Rabbi Johanna to Rabbi Hiyya, who was ill. "He gave him his and he raised him" (Berakoth 5b). In every generation, even in the early twenty-first century, some teachers (rebbes) have been folk healers and experts in Jewish medicinal lore.
Jewish folklore derives its particularity from the letters, symbols, pictures, prayers, stories, incantations, and passages that come from holy sources. They derive healing power from Hebrew, the language of the Bible and so of God. Hebrew letters and verses are placed in amulets to be worn around the neck, carried in one's pocket, and placed at sick beds. On their home's front entry and doorways within, many Jews place a prayer case (mezuzah), which contains a parchment scroll with protective biblical sayings. Changing the name of a sick person to Chaim ("life"), Rafael ("may God cure"), or the like and thereby changing his or her identity deflects the divine decree of death. Herbs from Sabbath services or unleavened bread from a Passover Seder can be medicinal. Some folk recipes, such as chicken soup, a common restorative since medieval times, may have had a more rational basis. These are but a few examples of Jewish healing practices that are still prevalent, especially in traditional communities, though marginalized like other forms of "alternative medicine."
The attitudes of Jewish religious texts toward physicians changed from initial disdain to respect, even reverence. The Bible is scornful; it remarks sarcastically that before King Asa died, he "did not turn to the Lord but to physicians" (2 Chr. 16:11). However, the postbiblical text Ben Sira, written two centuries after Hippocrates (fourth century bce), praises physicians. "From God the doctor has his wisdom," Ben Sira says, and "God makes the earth yield healing herbs" (Ben Sira 38). Following Ben Sira, the Talmud acknowledges that the physician has been "given permission to heal" (Mishnah Kaddushin 82a). It allows physicians to set fees and urges people to settle in a town where a physician resides and to consult doctors when they are in pain. Furthermore, it discusses the issue of whether a patient should follow a doctor's advice when the patient disagrees. With finality, the Shulhan Arukh declares that physicians have, "under the rule of saving an endangered life," not just permission to heal but, more importantly, an obligation, a religious duty to do so (Yorah Deah 335).
Since the early Middle Ages, Jews have held Western medicine and physicians in high esteem. Historically, Western medicine stems from the writings of Hippocrates and Galen, and it is based not on divine intervention or superstition but on a rational, book-learned science of observation, experiment, and theory. In the sixth century the otherwise unknown Asaph wrote the earliest Jewish medical text, which intermingles Hippocratic ethics with faith in God. In the tenth century the Moroccan physician Isaac Israeli authored treatises based on Galenic and Arabic medicine that became standard teaching texts throughout Islamic and Christian lands. In the twelfth century the author of the Mishneh Torah, Moses Maimonides, who practiced medicine at the court of Ṣalāḥ al-Dīn, achieved such notoriety as a clinician and writer that even for Islamic historians he typifies the remarkable accomplishments of an innovative era of Islamic medicine. Like him, learned Jews, even rabbis, became physicians not only to their own people but also to caliphs, sultans, popes, and Christian rulers. Following this professional tradition, many Jews, then and now, have regarded scientific medicine as a spiritual calling, second only to the work of a rabbi.
Since the Enlightenment, Jews have entered the health professions in greatly disproportionate numbers and have made many important contributions to medical thought and science. Hospitals in the United States created in the nineteenth and twentieth centuries for Jewish doctors and observant patients are now renowned medical centers. In its short existence, Israel has created a universal medical system in which care, teaching, and research are as advanced as any in the world.
The earliest Jewish physicians were inclined to write about professional excellence—to consider, that is, the question of what makes a doctor consummate—and thereby, like Asaph, to blend faith and profession. At a time of no medical licensure, no formal medical education, and no standardized professional standards, Isaac Israeli authored a book of moral and professional maxims, which includes the directive "Be especially concerned with visiting and treating the poor and needy sick for you cannot assume a more rewarding work." In a medical treatise, Maimonides emphasized that one should consult only the best physicians, meaning those who have thoroughly learned medical science and have extensive practical experience. Later Jewish physicians composed personal oaths, among them the famous Prayer of Maimonides, which though attributed to Maimonides, was written by a prominent eighteenth-century German physician. "Almighty God," it begins, "… inspire me with love for my art and for thy creatures. Do not allow thirst for profit, ambition for renown and admiration, to interfere with my profession."
Religion and Health
The basis of Jewish concern for healing is the belief that healthiness is a spiritual virtue. Jewish attitudes toward the body derive from the belief that the human body-soul, whether a unity or a dyad, is God's creation; it must be preserved to fulfill God's will on earth. Life is sacred; death is evil, although there will be, in some form, afterlife in messianic times. Jewish teaching sanctifies deeds and behaviors more than a transcendent spirit and so does not privilege soul over body; accordingly, Judaism disapproves of self-inducing illness by mortification and asceticism.
Judaism has no overarching healing concept; indeed the etiologic premises of the miracle, scientific medicine, and folklore are irreconcilable. Maimonides offers the only systematic formulation of the relationship of health to Jewish spirituality. His health concepts stem from the translated writings of the ancient Greek writers Aristotle, Hippocrates, and Galen, which he refined; his spiritual beliefs stem of course from the Hebrew Bible and the Talmud; therefore, with respect to medicine and healing, he tried to harmonize the literary heritages of Greece and Israel. A person's spiritual need, Maimonides wrote, is to acquire knowledge of God, and all actions in life should be directed toward that goal. Consequently, "the purpose of [the] body's health is that the soul might find its instruments healthy and sound that it can be directed toward the sciences and toward acquiring the moral and rational virtues. … On the basis of this reasoning, the art of medicine is given a very large role with respect to the virtues. … To study it diligently is among the greatest acts of worship" (Commentary on the Mishnah, chap. 5). In other words, good health is necessary, even sacred, in Jewish life but never as an end in itself; rather, it is subordinate to the end of leading a life consecrated to God. Good health makes possible a good life, which for the religious Jew consists of worship, study, and mitsvot.
Conversely, Jewish sources suggest that a good life may promote good health or at least emotional well-being. Proverbs advises: "Fear the Lord and shun evil. It will be a cure for your body" (Prv. 3:7). And if someone feels pain, the Talmud says, "let him engage in the study of Torah" (Erubin 54a). Maimonides told an Arab prince that "passions of the psyche produce changes in the body." To gain "strength of mind," study philosophy and follow the "admonitions and disciplines of the Law" (Regimen of Health). According to Rebbe Nachman of Breslov (1722–1810), "joy and dance," elements of Hasidic religiosity, relieve distress. The person utterly imbued with faith, in the words of a modern Orthodox theologian, "knows no fear or dread in the full sense of the term … [and] vanquishes even the fear of death" (Soloveitchik, 1983).
Sickness and Spirituality: Contemporary Developments
How do Jewish healing traditions have relevance in the early twenty-first century for the person who is ill? Many people still find comfort and inspiration in biblical writings, especially in Psalms. The Bible voices, acknowledges, and shares the sufferer's inner storm of anger, dread, pain, shame, bewilderment, and tears, and it holds out hope, order, and coherence. Family, fellowship, prayer, and communal support from congregations and social service agencies mitigate the lonesomeness, bitterness, and devitalization that often accompany chronic disease. Clergy who are trained in hospitals as pastoral counselors offer solace, perspective, and attentive listening. Jewish medical ethics is a vital field of literature and education and the subject of an ongoing dialogue between physicians and rabbis. Finally, many Jewish practitioners in the healing professions have internalized their spiritual heritage, write about it, and exhibit it in their daily work.
A voluminous literature deals with various elements of the subject of Judaism and healing, yet there exists no single, comprehensive source. One might start with the three texts listed below and then follow one's interests to other books listed in their bibliographies. Those in turn provide extensive references to periodical literature.
Berger, Natalia, ed. Jews and Medicine: Religion, Culture, Science. Philadelphia, 1995. Historical essays.
Dorff, Elliot N. Matters of Life and Death: A Jewish Approach to Modern Medical Ethics. Philadelphia, 1998. Religious law.
Freeman, David L., and Judith Z. Abrams, eds. Illness and Health in the Jewish Tradition: Writings from the Bible to Today. Philadelphia, 1999. Spiritual anthology.
Soloveitchik, Joseph B. Halakhic Man. Philadelphia, 1983.
David L. Freeman (2005)