In his book The Illness Narratives: Suffering, Healing, and the Human Condition,1 Dr. Arthur Kleinman makes an important distinction between illness and disease. He writes:
Illness refers to how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability. . . . Disease, however, is what the practitioner creates in the recasting of illness in terms of theories of disorder.
We see this distinction between illness and disease clearly in Parashat Tazria in the laws concerning tzaraat,2 — a skin ailment sometimes translated as "leprosy," its diagnosis, and the treatment of those afflicted with it.
The priests are practitioners. They want to know exactly what disease this person with a skin rash has, what are its symptoms, and — most important — what the person did to "get" the disease. In Leviticus 13:2-3 we read:
When a person has on the skin of the body a swelling, a rash, or a discoloration, and it develops into a scaly affection on the skin of the body, it shall be reported to Aaron the priest or to one of his sons, the priests. The priest shall examine the affection on the skin of the body. . . . when the priest sees it, he shall pronounce the person unclean.
The proclamation of "unclean" is the same as a diagnosis, like the words "cancer" or "shingles." It is not just a statement of judgment, it is also "medical terminology" in the ancient world.
While this week's portion, Tazria, is concerned with the ailment's diagnosis and treatment, next week's parashah, M'tzora, is concerned with the "clean-up" after the diagnosis. In our ancestors' world, all sickness seemed incurable by human beings, and so its root cause also could not be human. Thus, however a disease "presented," its origin must have been from God. In our parashah the word tzaraat in Hebrew is used to describe various kinds of skin ailments. The Rabbis of the Midrash, remembering that Miriam gets afflicted with tzaraat after she speaks ill of Moses' Kushite wife in Numbers 12, imagined that tzaraat was a punishment for motzi shem ra — "speaking badly of someone" (Midrash Vayikra Rabbah 16:1-6). The Midrash understands the law of leprosy as an allusion to seven traits that God abhors, enumerated in Proverbs 6:16: haughty eyes, a lying tongue, hands that shed innocent blood, a heart that devises wicked thoughts, feet that run eagerly toward evil, a false witness, and one who sows discord among people.
Yet while the Torah is concerned with the actual illness, the person with the illness is also living the experience, and the Torah acknowledges this. Tazria is not only about a disease, but it is also about, as Kleinman says, "how the sick person and the members of the family or wider social network perceive, live with, and respond to symptoms and disability." In some cases, treatment of skin ailments involved separating the afflicted from this community (see for example, Leviticus 13:4-5; 21, 31).
The Torah sees skin ailments, and any other form of illness, as a liminal zone, the strange land between life and death. When Miriam gets leprosy after the slander against Moses, Aaron says to Moses, "Don't let her be like one half dead coming out of the womb . . ." (Numbers 12:12). Why? Because we live embodied — with an embodied Judaism that is in our flesh, not just in our minds.
Leviticus' concern is to establish a clear boundary between life and death, but that strict demarcation is troubling: shouldn't the Torah mandate us to welcome and comfort the afflicted instead of expelling them? After all, for the Sages, "visiting the sick," bikur cholim, is a form of "walking in God's ways" (Babylonian Talmud, Sotah 14a). They further state that a visitor to the sick takes away 1/60th of the afflicted person's illness with every visit (Babylonian Talmud, Bava M'tzia, 30b). So why the dramatic exception in the case of the m'tzora, or leper, who is declared unclean and instructed to remain outside the camp, isolated and alone?
In our next parashah, M'tzora, we receive an answer in the form of an elaborate ritual that evokes the ceremony for priestly ordination (see Leviticus 14:1-32). Blood and water are sprinkled on the person's extremities, just like in the ceremony of the ordination of priests. The former m'tzora is welcomed back into the community with open arms and communal affirmation, and like the priest who himself diagnosed the uncleanliness, the leper is "anointed."
All this serves to show that in determining a solution to the problem of tzaraat, the Torah is concerned with what happens after the cure. The Torah is trying to prevent permanent stigma from being attached to one who has been afflicted by tzaraat. Bible scholar Rabbi Dr. Tamara Cohn Eskenazi observes:
Leviticus . . . also concentrates on reconnecting the persons who have been isolated and on bringing them back to the center . . . Leviticus 14 illustrates the tremendous investment in the social and religious reconnection and rehabilitation of persons formerly stigmatized and excluded by virtue of the disease. The most marginalized, isolated person is reintegrated with an elaborate ritual, comparable only to that of the ordination of the High Priest.3
This week's parashah, together with Parashat M'tzora, asks us to look carefully at the potential for widening our own community for those ill in body, mind, or spirit, and commands us to concentrate fully on welcoming them back after whatever diagnosis and treatment they receive for the "disease," which does not change their integral humanity.
1. Dr. Arthur Kleinman, The Illness Narratives: Suffering, Healing, and the Human Condition (NY, NY: Basic Books, 1989)
2. Tzaraat is sometimes translated as "leprosy." For more discussion about tzaraat please see W. Gunther Plaut, gen. ed., The Torah: A Modern Commentary, rev. ed. (NY: URJ, 2005), pp. 742-743
3. "Reading the Bible as a Healing Text," in William Cutter, ed., Healing and the Jewish Imagination (Woodstock, VT: Jewish Lights Publishing, 2007), pp. 77-94
Rabbi Elyse Goldstein is the founding rabbi of City Shul, downtown Toronto's new Reform congregation. Before that, for twenty years, she was the director of Kolel: The Adult Centre for Liberal Jewish Learning. She is the author/editor of four books on women and Judaism (published by Jewish Lights Publishing).