August 25, 2019

Conversation with the angel of death [1991]

The letter from Lillian came between Rosh Hashanah and Yom Kippur.

“I am writing to you as both my friend and my rabbi, driven by the deep sadness and sense of disconnectedness that has gripped me since this morning's Rosh Hashanah service.

Until this morning. I know the central liturgy of the holiday well, but before this year I had approached it in an abstract, intellectual manner. This year, I could not do so. Several months ago I had surgery for cancer, and I felt very keenly as I approached these days that in a real sense my fate for the coming year has been written, if not in a book of judgment, then in my own body. I look forward to health, but I may not be granted it. As I read, the questions of the service were familiar: “How many shall pass away and how many shall be born; who shall live and who shall die?” But the response — “repentance, prayer, and righteousness avert the severe decree” — for the first time carried a terrifying implication. It seemed to me as I read this that my own liturgy was binding my fate to my behavior, that my illness, seen in this light, has been the result of some terrible unknown transgression, and that the ultimate punishment for failure to discover and correct it could be my death.

I do not believe this — not with my head nor my heart. Nevertheless, as a committed Jew who takes language very seriously and believes in community prayer, I would be forced to repeat this central cornerstone over and over should I attend services for Yom Kippur. It seems today that my choice is a terrible one: to flagellate myself emotionally by joining my congregation or to spare my feelings by isolating myself from my family, my friends, my community. It is a choice I never believed I would have to make.

I know there must be others in our congregation who sit suffering silently, as I did today, who wish to join Jews around the world at this time but find the price too high to pay. I do not write expecting an easy answer; holocaust literature has taught me there may be no answer at all. I write instead because I must, because to muffle my sadness and my anger will destroy something in the commitment I have worked so hard to build. I write from pain, hoping that from the expression of my dilemma will grow some insight, some way to cope.”

There are times when religion is a matter of life and death. When it is not about getting the right seat in the sanctuary at High Holy days, or the convenient scheduling of the Bar Mitzvah or the catered wedding. There are times when religion, God, faith, prayer are truly taken to heart. Conversations around the hospital bed cut through the intellectual subtleties of theology into hard core of being, the amenities of wishing each other “a good writing and sealing” for the New Year. Facing sickness and death, our own or our family's or our friends, the foundations of our being are shaken. We pray differently then and we think differently then. We pray and listen hard. Lillian's letter would not let me go.

SANDRA IN THE HOSPITAL

Around the same time I received the letter, I was informed that another congregant, Sandra, was seriously ill. At our first conversation, Sandra began softly,

“Please, Rabbi, don't lie to me. I have a fatal form of leukemia, and I know that I am dying. The doctors have been frank with me. I have two small children who go to your school. I love them and they love me. I have wonderful parents and a marvelously supportive husband. But I cannot make sense of it all. I don't ask 'why me?', but 'what for?' Life for me has been drained of all meaning. What have I these remaining weeks or months to live for. My children have given me so much meaning. I looked forward to being their mother. But I know now that I will not be able to raise them. My future has been cut off.”

She told me that when she was in the hospital before Rosh Hashanah, a Rabbi had visited her and blown the shofar for her in the grim hospital room. She was grateful. He inquired as to the nature of her illness and then asked whether it was her practice to light Sabbath candles. She said she did and he answered, “Well then, you have nothing to worry about.” He meant it as an assurance. But she thought, “What would he have said if she had answered no, or if he had asked her if she kept kosher?” At any rate, Sandra turned away from him, buried her head in the pillow and sobbed.

I thought of Lillian's letter and Sandra's resentment. But Sandra was too agitated and too ill for theological discussion. She was inconsolable and I wanted to make her better, to cheer her spirits. A book was brought to my attention, a best-seller by Dr. Bernie Siegel, a surgeon. The book is entitled Love, Medicine, and Miracles, and its subtitle read “Lessons Learned About Self-healing From A Surgeon's Experience With Exceptional Patients.”

In my eyes Sandra was an exceptional patient. The book was filled with statistics, evidence, anecdotal accounts of patients successfully coping with death-threatening cancers, and cases of multiple sclerosis, arthritis, diabetes, heart disease, AIDS. Here were terminally ill patients who beat the odds. Resilient, adaptable, confident, with an unquenchable will to live, they defied the gloomy prognostications of their doctors, stuck their tongues out at their lugubrious predictions and refused to curl up and die.

These were the exceptional patients who refused to go gentle onto the operating table, whom — according to Siegel — doctors don't like because they are inquisitive, demanding, aggressive, “bad” patients. These are the patients who don't venerate the physicians or surgeons as M. D.'s — an acronym, cynics say, for Medical Deities, and who if they are not satisfied, change doctors.

Before reading the book, Sandra told me of the doctors' terrible prognosis. I told her that doctors are not prophets and that according to the Sages, “Prophesy in our times has fallen into the hands of children and fools.” “Sandra,” I said, “remember doctors are not Gods.” Sandra liked that, told it to her doctor who responded, “Well, neither are Rabbis.”

Now I had a book written by a surgeon of oncology to shore up her spirits. The book I gave Sandra started out with a bold statement from Norman Cousins' Anatomy of an Illness, “Patients divided themselves into two groups. Those who were confident they would beat back the disease and be able to resume normal lives and those who resigned themselves to a prolonged and even fatal illness.”

Those who had an optimistic view had a higher percentage of “discharged as cured” than the others in the tuberculosis sanitarium where Cousins was sent. There appears to be a “physiology of optimism.” There are peptide molecules in the body releasing “wonder drugs within”: endorphins, interleukims, interferons.

I've liked Norman Cousins ever since I heard about his advocacy and practice of watching Marx Brothers films as a form of therapy. My own cardiologist, I decided, has no sense of humor. Siegel throughout maintains that “instead of turning fighters into victims, we should be turning victims into fighters.” The book is sprinkled with success stories of exceptional patients whose attitude and will gave them hope and extended their lives. I meant the Siegel book to help her. But it boomeranged on her. The book angered, then saddened her. I re-read the book this time through Sandra's eyes.

THE VICTIM'S GUILT

For Sandra, the success of the exceptional patients was her failure, their victories her defeats, their cures her misery. “What's wrong with me. I have tried, God knows I have tried. I have gritted my teeth. Taken the chemotherapy, the medicines. I have given love and been loved in turn. Why can't I will myself into wellness like those others?”

Psychological literature speaks of “survivors' guilt”, those tortured by their good fortune to survive while others fall. Soldiers who have seen their buddies wounded and killed while they leave the battlefield unscathed; survivors of concentration camps who witnessed the suffering and murder of their fellow inmates while they are spared. Sandra was suffering from “victim's guilt”, the guilt of the failed, the ordinary, unlucky, condemned. She couldn't forgive herself for her unexceptionality.

I read it again and then read Siegel's new book, Peace, Love, and Healing, a clone of the first book, to better understand Sandra's reaction. There Siegel quotes with favor a novelist who writes that “Illness doesn't strike randomly like a thief in the night. Certain kinds of people at certain points in their lives will come down with certain ailments. You can almost predict it.”

He cites Ray Berti, a college professor at Massachusetts battling throat, bone marrow and other types of cancer for fourteen years, who finally sees the light. “The critical thing for me was when I said to myself, 'Ray, somehow or other you're causing it. I am the cause.'” Paradoxically, the book which intended to offer her morale, to rid the patient of passive dependency, delivered a double whammy. First, she felt responsible for her lack of attitude that made her susceptible to the disease, and now she felt responsible for not snapping out of it.

I understand Siegel's argument that patients become too acquiescent, passive, and dependent; that patients frequently abandon their responsibility. The reversal of that dependence was popularized two decades ago among psychological cults. As one of the celebrated psychologists put it, “I am me. Therefore everything that comes out of me is authentically mine because I alone chose it. I own everything about me. My body, my mind, my eyes. I own my fantasies, my dreams, my fears, my triumphs, my failures, my mistakes. I own me and therefore I can engineer me. I am me and I am okay.”

If you are indeed all that, you have no one to blame but yourself, you are the cause. I have a rabbinic friend who a few years ago found himself immobilized, his bodily movements painfully restricted. The paralysis was shown not to be organic. He consulted all kinds of doctors and psychologists and was recommended to a psychologist whose specialty is hypnosis. After going there, he told the doctor, “I'm not being helped.” “You will be helped,” said the psychologist, “when you're ready.” So the failure to recover was a failure of will. Not can't but won't blocks your cure.

Paul Cowan, the author, in his last article for the Village Voice (May 17, 1988) before his own death from leukemia, commented on the need to confront the awesome, mysterious power of his disease. “Otherwise, if the leukemia cells re-enter my bone marrow, I run the risk myself for relapsing and if I continue to weaken, of raging at my psyche instead of fighting back.” The dark side of faith in will is self blame.

THE DOUBLE EDGED SWORD OF WILL

This is part of the new tyranny of the will. We live in a climate of desperate voluntarism. We are raised to believe in the omnipotence of the will. We have been read to in our childhood and pass its theology onto our children. The little engine chugging its way up the mountain with the endless refrain: “I think I can, I think I can, I think I can, I think I can…” until triumph flashes, “I knew I could.”

We live in a popular culture of will and wish. Peter Pan reaches out to the audience to have it pray with the hands to revive Tinker Bell. And we do it. Faith will revive. Faith will resurrect. Faith will redeem. Faith will cure…if you only believe yourself into recovery. Will is the secular form of faith. Will can move mountains and remove illness. Things just don't happen. We choose them. We make ourselves sick and well.

So Siegel declares, “Psychologists long ago discovered that emotions can be modified merely by adopting the facial expression of a contrary emotion.” Indeed Dr. Paul Ekman of U.C. at San Francisco distinguishes 18 anatomically different types of smiles. It calls to mind Dr. Smiley Blanton, a popular psychologist, who would convince his audiences that with their cooperation, he could convert their sadness to happiness. He would instruct his audience to smile and when they parted their lips and showed their teeth, challenged them to be simultaneously sad. “When you smile,” he concluded, “you control your emotions.” Smiling has made you happy. Photographers have developed this philosophy into a photogenic technique. “Look happy Rabbi,” they instruct me, asking me to stop eating and stand behind the other seated guests. I don't look happy because at the moment I'm not happy, and smiling is not the appropriate expression now. “Say cheese,” the photographer advises. I obey and later, after the film has been developed he boasts that he had captured my happiness. Others, seeing the picture, comment on my joy. In truth, however, the photographer had not immortalized happiness, he had only captured “cheese.”

The triumphalism of the will ignores what wisdom understands: the limitations of will. I can will my smile–I cannot will my happiness. I can will my eating, I cannot will my hunger. I can will going to sleep, I cannot will my dreams. I can will knowledge, I cannot will wisdom. I can will my self-assertion, I cannot will my courage. I can will shaving, combing, dressing up–I cannot will my joy. I can will purchasing flowers, perfume, candies–I cannot will love. I can will fasting, the recitation of the litany of transgression–I cannot will remorse. I can will opening the prayer book and Bible–I cannot will belief. “A wink is not a blink.” One I will, one I do not. I can will many things, but I cannot will my will.

During my own past illness, I recall feeling frightened and sad and later at night turning to a channel which fortuitously, was showing “A Night At The Opera,” a Marx Brothers classic, Norman Cousins' counsel did not work with me. I did not laugh. The Marx brothers were not funny, nothing was funny. I could not will feeling funny. Should I have felt failure because of my inability to laugh? How have I no sense of humor now that I need it?

A JEWISH VIEW OF WILL

Judaism celebrates freedom of will. It has from the time of the Bible on struggled against pre-destination theologies, against fate. But there is a deeper wisdom in Judaism — a Reality Principle — that knows the limitations of will. Judaism present s more balanced portrayal of the human condition.

“By dint of force are you born. By dint of force you die.” And that helps me interpret differently the “who shall live, who shall die?” prayer that troubles Lillian.

“How many shall pass away and how many shall be born; who shall perish by fire and who by water, who by earthquake and who by plague?” I do not know. For these matters are not matters of will–neither my will, your will, or God's will. For me the litany refers to natural events, births, deaths, accidents, sicknesses over which I have no control. They are not God's punishments or rewards. What then are they? If they are not the “acts of God” are they the acts of the Devil?

The Talmud (Avodah Zarah 54b) is helpful here. It refers to “the ways in which Nature pursues its course.” The Talmud uses this expression in arguing against a simplistic explanation of patently immoral events. The sages ask, “Suppose a man stole a measure of wheat and then sowed it in the ground. Clearly it would be right for that wheat not to grow. That would be the 'din', the judgment were this a case brought to the rabbinic courts. But 'the world pursues its own natural course and as for the fools who act wrongly (i.e. for those who stole the wheat) they will have to render an account.'” They offer another illustration: Suppose a man has intercourse with his neighbor's wife. It would be morally right that she should not conceive but we must acknowledge that “the world pursues its natural course and as far as the transgressors who act wrongly are concerned, they will have to render an account.”

I understand the sages to be cautioning us not to confuse biology with morality; not to confuse the procreative process with the process of the law; not to confuse physical laws of nature with moral laws. Every event has a cause but not every cause is morally determined. Every event has a reason for occurring but not every event has a purpose in occurring. The cancer I have is not God's curse for my sin. The heart attack is not God's punishing rod to whip me into repentance. Not all events are judgments.

There are consequences to my taking a contaminated needle for the sake of transfusion. My contraction of AIDS is a consequence but a consequence is not a punishment, and a reason explaining why a sickness occurs is not a moral judgment. The infant born addicted may be a consequence of the substance abuse of its parent, but consequence is not purpose or judgment or justification for the addiction. Such distinctions must be drawn if we are not to condemn ourselves to lives of masochistic dread and guilt or to turn God into an indiscriminate punisher.

Nature is not God. And to treat nature as if it were God would convert every fact into a moral judgment. An earthquake into God's smoldering anger against sinners, rainfall into a reward. That outlook breathes a spirit animism that sees ghosts in rocks and waters, in lesions in the skin and leprous rashes. That theology turns sado-masochistic. Unintentionally, it turns God into a mysterious sadistic God and man into a masochist with a taste for suffering.

Those who seek desperately for justification of evil and suffering frequently turn to the “Helen Keller defense” popularized in a poem. “At birth deny a child vision, hearing and the ability to speak and you have a Helen Keller. Raise him in abject poverty and you have an Abraham Lincoln. Stab him with rheumatic pain until opiates are needed and you have a Steinmetz.”

The truth in the argument is that there are people who can make virtue out of necessity, who can transcend suffering and use it to spur them on to greatness. The falsehood in the argument is in pointing to heroism and courage as justification for human suffering, agony and death. That mentality would argue that poverty is good because it gives people an opportunity to be charitable; that sickness is good because it offers medical science challenge, that suffering is good for it tests character. With some theologies, the facts of sickness, suffering and death are converted into divine intention. Purpose is read into calamity by interpreting it as either God's punishment or God's reward. What “is” is turned into what “ought to be.”

Dr. Siegel writes, “I suggest that patients think of illness not as God's will but as our deviation from God's will.” He thinks patients must acknowledge “the absence of spirituality” in their lives. To avoid blaming God and therein the assumption of the patient's responsibility, Siegel inadvertently turns the patient into a scapegoat.

To see in illness a deviation from God's will is a retrograde piety. Who shall end up in hospital or hospice and who shall remain healthy is not a matter of will, divine or human. If it were, life would be filled with false guilt, blame and accusation. Sickness would justify the infantile unending taunt: “It serves you right. You get what you deserve.” Susan Sontag (AIDS And Its Metaphors) recalls painfully the fictions of responsibility that attended her becoming a cancer patient. Cancer was regarded as a disease to which “the physically defeated, the inexpressive, the repressed” are particularly prone.

BLAME

This society is saturated with the need to blame, to find fault. It is as if there cannot be any explanation of events without someone to fault. How remarkable the Talmudic insight “nature pursues its own course.”

Elsewhere Dr. Siegel contends, “I feel that all disease is ultimately related to a lack of love…that all disease is ultimately related to the inability to give and accept unconditional love.”

That bit of generalizing philosophy unintentionally adds insult to injury. Sandra loved deeply, loved her family, her friends; she was involved in the synagogue, with the developmentally disabled. She was gifted with social conscience. Inadvertently, Siegel ends with blame of the failed patient for not having the right kind of self-love or altruism. He is caught up in a secular guilt trip.

LILLIAN'S LETTER

I return to Lillian's letter and to the conversation I had with her. For her the “who shall live and who shall die?” prayer sent a shiver in her, a threat of future punishments for past transgressions. And the more hopeful conclusion that repentance, prayer, and charity would avert the evil decree rubbed salts in her wounds. Had she not lived, repented, prayed, and been charitable before she contracted her illness? And is that illness a “decree,” a verdict, a judgment upon her from up high? How should she understand the prayer? How do I pray the “netaneh tokef?”

For me the Netaneh Tokef questions with which the prayer opens means that there are areas in life over which I have no control. It confesses my creatureliness, my dependence on nature. There are amoral features in nature which should not be explained as if nature were a rabbinic tribunal. Part of the prayer expresses the Jewish reality principle. I accept the laws of nature, the withering of the leaves, the breaking of the boughs, the miscarriages in birth, the congenital and non-congenital disease. I accept the limitations that nature places on me. Moreover, Judaism does not encourage me to pray for a suspension or modification of the laws of nature. Judaism's reality principle calls prayers that seek to reverse the laws of nature, that pray that what events take place did not “tefillat shov”, vain, empty prayers. Jewish faith is not magic.

Much as I would desire it I cannot pray away the damage done to my heart nor pray away the tumor from my colon nor will the growth of arms and legs onto my paraplegia.

But that wisdom of acceptance is not the acceptance of impotence, that reality principle does not paralyze the proper areas and functions of my mind, heart and will. That is the meaning of “turning, prayer, and charity.” Those are the areas over which I do have control. I cannot alter the world of nature outside, but I can effect the world within. As Albo in the Ikarim asserts, my prayer actions do not change God; they change me. (IV Chapter 18)

Maimonides (Hilchoth Avodah Zarah 11-12) offers a crucial distinction between the healing of the body and the healing of the spirit (refuath ha-guf; refuath ha-nefesh). “To read a scriptural verse or place a Torah or a pair of tefilin on a child so that he may sleep is not only the way of diviners and fortune tellers, but it uproots the Torah — for they who practice in this manner make the Torah a healer of the body whereas the Torah is a healer of the spirit.”

Jewish faith-healing does not pretend to cure the cancer with the willful laying on of the hands. God is not found in the leukemia. God is found in the character and meaning latent in the patient. Meaning is not in the deafness or blindness or muteness or lameness–that is nature's course, not God's will.

When Sandra asked what meaning in the life remained to her which was tied up to her raising her children, we explored the possibilities of meaning. Sandra agreed that she wanted to raise them to be strong, to help them learn how to cope with the abrasiveness of life, how to face the challenge of adversity. Are these not the wishes of a mother?

“Your children, Sandra, know how sick you are. And you are teaching them lessons they will cherish the rest of their lives. Sick and suffering, you teach them how to love, how to cling to faith. Living, you teach. Dying, you teach dignity, courage and meaning. And so it is with your husband and your family and your friends. Sandra, you are meaning. There is a midrash that informs that 'the righteous are informed of the day of their death so that they may hand the crown to their children.'”

I would not lie to Sandra or Lillian or to myself. Who shall live or die, how long I shall live is not in our control. And God whom I worship is no enemy of mine, no implacable, inaccessible Judge. God is my ally, my strength and my friend. And as I tap into the curative forces within the soul into which God breathed life, I may make my life a blessing. Tshuvah, Tefillah, and Tzedakah cannot save me from death, but they can give me more life.