Parashat Tazria-Metzora, 5764, Art Reingold
Parashat Tazria-Metzora
Leviticus 12:1 - 15:33
24 April 2004 / 3 Iyyar 5764
Art Reingold, M.D., M.P.H., UC Berkeley School of Public Health
Shabbat shalom.
When I was asked to give the drash this week, the tacit assumption was that because I make my living as a professor who studies public health and infectious diseases, I was the obvious choice to do so. After all, parsha Tazria and parsha Metzora focus on a skin disease called tzaraath, commonly translated as leprosy, and tzov, which is politely referred to as an issue. However, as I began to study and consider what to say this morning, I realized that I was going to confront some unexpected challenges. First, as a professor, I never speak for less than 50 minutes, and I often have almost three hours at my disposal. But my instructions were clear - 10 minutes was fine, but at 15 minutes the hook would be coming out. Second, I was going to have to go without overheads, slides, and PowerPoint. Third, in my marriage we have a strict division of labor - my wife, who is the Director of Sexually Transmitted Disease Control for California, handles all the issues and I don't touch them. Nevertheless, I can't pass up the opportunity to digress and point out that current misconceptions about the possibility of contracting sexually transmitted diseases from toilet seats may well be traceable directly to the notion that mere contact with saddles and beds and clothing that have been in contact with someone with an issue makes someone impure.
That leaves me with tzaarath, which it turns out is almost certainly not leprosy. I suppose I could have talked about why women who give birth to a male infant are ritually unclean for seven days, while women who have given birth to a female child are ritually unclean for two weeks, but I wouldn't touch that with a ten-foot pole in an egalitarian synagogue in Berkeley. So I'm stuck with tzaarath, which may derive from the word zara, meaning to sow, as in a sowing of lesions on the skin, or from an Arabic word meaning "to strike down" or "scourge" or metzora, which is also said to derive from motzi rah - "who brings out evil." And since I've always been taught to tell people what you're going to tell them, then tell them, and then conclude by telling them what you told them, let me give you the bottom line right now. Like Julius Preuss, whose book, "Biblical and Talmudic Medicine," is considered the definite work on all aspects of medicine and health in the Bible, I'm at somewhat of a loss to explain tzaarath. Preuss said, "I differ from my predecessors in that I do not understand numerous details of the chapter on tzaarath. I even believe that the explanation of some of these details is impossible to elucidate." Admittedly, Preuss has problems with details, while I have broader, conceptual difficulties.
There is no doubt that these portions of the Bible, like the ones that precede and follow them, are about ritual purity and impurity. Just as parsha Shemini makes it clear that what enters your body in the form of food can make you ritually unclean, these parsheot make it clear that what comes out of or is on your body can also make you ritually unclean. In his book, "Impurity and Sin in Ancient Judaism," Jonathan Klawans points out the important distinction between ritual impurity and moral impurity. Moral impurity results from immoral acts, such as sexual sins, idolatry, and murder (in other words, your good old-fashioned abominations). Moral impurity deriving from such acts brings defilement and ultimately results in punishment or exile. There is no contact contagion of moral impurity. Ritual impurity, on the other hand, is produced by natural and, in some instances, unavoidable conditions and circumstances, such as childbirth, menstruation, and contact with corpses. It is not sinful to contract ritual impurity from such sources, and the impurity is impermanent, but it is also transmissible to others.
According to the Misnah, sin and ritual impurity are not necessarily linked. Sinners are not defiling unless they have the afflictions or contact that produce ritual impurity, and repentance is not synonymous with purification. Tzaarath, while a source of potentially reversible ritual impurity that can be transmitted to others, appears to occupy a unique position because of the strong suggestion in the Torah and in later works that it is a form of divine punishment for certain sins, particularly for slander or evil talk (lashon harah). Most prominently, Miriam was temporarily afflicted with Tzaarath for speaking ill of her brother, Moses. At the same time, however, there are strong suggestions in various commentaries and sources that Tzaarath itself, rather than just the ritual impurity it conveys, can be transmitted to others, even if they themselves have not committed slander or other evil deeds.
Thus, when I said I have broader conceptual difficulties understanding Tzaarath and its meaning, I was, in part, referring to my lack of clarity about whether Tzaarath is meant to be considered a naturally occurring condition, which happens to convey ritual impurity, or is invariably a form of divine punishment. In various sources, one can readily find support for either position. If tzaarath is a form of divine punishment, why is slander or evil talk, of all of man's misdeeds, worthy of such severe punishment? While slander is said to cause irreparable damage and to gather momentum as it spreads, does it really warrant such awful punishment? If so, at least it becomes clear why our daily prayers end with the prayer, "Oh my God, guard my tongue from evil and my lips from speaking guile."
It is important to note that the role of the priest when confronted with someone with possible Tzaarath is to make a diagnosis, not to heal the affected individual. Healing can come only from God, not from the priest. In this respect, Judaism differed from other religions of the time. The priest's other role is to re-examine someone with Tzaarath to determine when healing has occurred and if it has, to perform a purification ceremony, ending the person's ritual impurity. The Torah provides the priest with a painstakingly detailed set of criteria for deciding who has Tzaarath and when it is healed - it is these details that Preuss admits to not understanding, despite his training as a physician and his years of studying the matter. Suffice it to say that it is also these details that make it unlikely that Tzaarath refers uniquely to the disease we now call leprosy. If you want to understand why, you may need to go to medical school.
If the Torah is detailed in its listing of the criteria for determining who has Tzaarath, the Talmud and the Mishnah are even more detailed in describing how to apply these criteria. An entire tractate of the Mishnah, consisting of 14 chapters, is devoted to Tzaarath, as is a substantial part of Maimonides' "Book of Cleanliness." In these works, we learn everything from how the priest is to conduct the examination and whether a priest with weak eyesite or who is mentally ill can perform it. We even learn from Maimonides that "if a man who is clean enters backwards into a house affected with Tzaarath, even if all of him enters except only his nose, he remains clean." And, we learn that an individual with Tzaarath who is healed of his condition is not restored to ritual purity unless and until the purification ceremony has been performed, which means that an individual missing one of the body parts that must be included in this ceremony (the right ear, the right thumb, and the right big toe) may not be able to return to ritual purity, despite being healed!
What I find most difficult to understand about Tzaarath, however, is why it, among all the afflictions and diseases of mankind, was singled out for such attention. The most straightforward explanation is that it alone of all diseases is divine in origin. Other diseases and conditions, including other skin diseases, are not similarly divine in origin and thus do not produce ritual impurity, however incapacitating, disfiguring, or disgusting they may be. Many diseases and conditions that are obvious to the casual observer and that are stigmatizing in many cultures are described with sufficient specificity in the Torah that we can be fairly sure they existed in biblical times. Fred Rosner, in his book entitled Medicine in the Bible and the Talmud, lists boils, bubonic plague, weeping inflammatory eye conditions, blindness, harelip, epilepsy, and mental disturbances, such as madness, among others. Apparently, none of these conditions conveyed ritual impurity and if the above argument is correct, they must not have been divine in origin.
At the same time, however, there is ample evidence in the Torah that at least some plagues of human disease afflicting entire populations were considered to be of divine origin, including one of the ten plagues inflicted on the Egyptians - shecheen, or boils. The view that plagues were divine in origin and a form of collective punishment was widely held in earlier times, at least in Greek, Roman, Egyptian, and early Jewish cultures. And, well into the 20th century, many Hindus in India believed that the goddess Shitala Mata had the power to inflict and to prevent or cure smallpox, and their fear of defying her led some to strongly resist vaccination, leading to some ugly instances of people being thrown to the ground and forcibly vaccinated against their will and against their religious beliefs. In her book, "AIDS and its Metaphors," Susan Sontag says, "Plagues are invariably regarded as judgments on society" and that "Interpreting a catastrophic epidemic as a sign of moral laxity was common until the latter part of the 19th century." Plagues were initially said to have been "sent by the gods," although later they were said to be "visited upon people."
Sontag also asserts that the word plague has generally been used only to describe epidemics of diseases that in some way mark the flesh or disfigure people, such as syphilis, leprosy, bubonic plague, and AIDS, and that the word is generally not used to describe equally large and deadly epidemics of diseases like influenza or polio. Further, Sontag says that "illnesses that do not damage or destroy the face never arouse the deepest dread, no matter how lethal they are" and that "underlying some of the moral judgments attached to diseases are aesthetic judgments about the beautiful and the ugly; the clean and unclean; and the familiar and the alien." Particularly relevant to tzaarath, in my view, is Sontag's notion that diseases that are mysterious and acutely feared will be viewed as morally, if not literally contagious, and that contact with someone afflicted with a disease regarded as a mysterious malevolency invariably feels like a trespass; worse, like the violation of a taboo.
Are the laws pertaining to tzaarath in this parsha intended to prevent contagion of the disease itself, or only of the impurity resulting from contact with the afflicted individual? While many have seen in these laws early public health efforts to isolate the affected individual and prevent transmission of tzaarath itself, it is worth noting that according to Rashi and others, the examination by a priest of someone suspected of having tzaarath is to be delayed in the case of a bridegroom until after the 7 days of wedding festivities are over and in all cases, until a festival is over - not a very good approach from a public health standpoint.
Before summing up my discussion, I think it is important to touch briefly on the question of the overwhelming stigma associated with tzaarath. Erving Goffman, a well known sociologist who spent part of his professional career at the University of California, Berkeley, defined stigma as an undesired differentness from what is expected, an attribute that is deeply discrediting, a spoiled identity. In the parsha, we learn that someone judged to have tzaarath must tear his clothes, let his hair go loose, cover his upper lip, and cry out "unclean, unclean!" Furthermore, he must live outside the camp or city. Such an individual becomes, in other words, a pariah, a social outcast, an untouchable - all current synonyms for a leper. In fact, leper became such a stigmatizing word that it is no longer acceptable in the medical or public health community to use the words leper or even leprosy - we talk instead of Hansen's Disease. Again, why is tzaarath, even if it isn't what we now call leprosy, the only disease in biblical times that is so stigmatizing? Interestingly, in the time of the Misnah, exclusion of those with tzaarath was not as strict and they were allowed to come to the house of study, although they had to be separated by a wall 10 handbreadths high and 4 cubits in width and had to be the first to enter and the last to leave. Some argue, however, that the term, tzaarath referred to a different, less feared and less contagious disease in the time of the Mishnah.
After all this meandering, what can we conclude about tzaarath? For some, the answer to any difficult to understand concept in the Torah is fairly simple. God moves in mysterious ways and we need not, indeed perhaps we ought not look for rational, human explanations. Even if the biblical laws concerning tzaarath are divine in origin, however, I am one of those people who needs to find a rational explanation. I am inclined to think that Susan Sontag has it about right - that tzaarath, even if it was not what we today call leprosy, was a disfiguring disease of cryptic origin that inspired fear of contagion of both the disease and the resulting impurity. Our ancestors reacted in ways not dissimilar to the reactions of other peoples and cultures before and since when confronted with mysterious, frightening ailments.
Shabbat shalom.