Friday, April 27, 2012

A Thought on the Parsha


Feel free to download and print this week's Parsha Sheet and share it with your friends and family: 
Click here:     Parshat Tazria-Metzora 
 
A person with a spot on his skin, needs to have it inspected by a Kohen to determine if it is tzara'at - a skin condition which renders him ritually impure.   If certain criteria are met, the Kohen will declare him impure.

In stark contrast to the active role of the Kohen is the way the Torah describes the person himself.  A close reading of the verses shows that this person has been reduced to an object, he becomes an object of scrutiny by the Kohen.  Consider: "A person, when there is on his skin a spot... shall be brought to Aharon the Kohen or one of his sons the Kohanim." (Vayikra 13:2).  The person here is not a subject, a person who has a condition, rather he is the object upon which the spot appeared.  The person is also not choosing to go to the Kohen, and not even going to the Kohen himself. He is rather being brought, by some unnamed others, to the Kohen.   He - or perhaps just his skin, or just the spot - is a thing to be brought to the Kohen for the Kohen's scrutiny. 

This objectification continues in the next verse: v'ra'ahu HaKohen vi'ti'mei oto  - "and the Kohen will see the spot" - the spot! not the person! - "and impurify him." (verse 3).  What or who is being seen and declared impure?  The person or the spot? The grammar is unclear: the two actions - seeing and declaring impure - can both be referring to the spot or both to the person, or - as the above translation would have it, one to the spot and one to the person.  All of the above possibilities exist in various English translations.  The message, however, is the same: at this stage the person and his spot are more or less interchangeable -he is his condition, and that is how he is being seen by the Kohen.
This implicit framing runs throughout the parasha. The person is never coming on his own, but is always being brought to the Kohen (see verse 13:9, 18), and the Kohen is always looking at the spot, not at the person.  The only time the person appears active - ever so briefly - is in verse 13:16, "If the healthy flesh once again turns to white, then he shall come to the Kohen... and the Kohen will purify the spot, he is pure."   When there is a chance of recovery -of no longer being a patient, as it were - the person becomes an actor and approaches the Kohen on his own. 

Now, we would expect that when the person is declared to have tzara'at, and must engage in a series of practices appropriate for a metzorah, that he would be described as an actor.  This is not the case.  The Torah rather emphasizes that these practices are something happening to him: "And the one with tzara'at who has the spot, his clothes shall be torn and his head-hair shall be wild, and on his lip shall he veil himself, and "impure, impure" he shall call out." (Vayikra 13:45).   He is active primarily to call out or bemoan his state. Once again, he is not a person who is acting, but rather a thing being acted upon.

What the Torah is describing here is not a punishment, but a sad, yet perhaps necessary, consequence of the doctor-patient relationship.  For a doctor to be fully objective and to carefully weigh the evidence in front of her, she has to bracket the humanity of the person sitting in front of her.   She has to objectify the patient, focus on the symptoms as they present themselves, in order to render the best medical judgment.   This need for objectification is explained nicely in the following article (from kittywampus.wordpress.com):

Modern, scientific medicine has historically objectified people as patients. Indeed, the "modern" and "scientific" elements of it rely on objectification. Modern medicine is founded upon objectification: People become case studies. Their complicated life stories are aggregated into statistics. They're assigned to control or experimental groups, and their individuality melts away.

Medical research as we understand it would be unthinkable without objectification. The techniques I just mentioned are necessary to doing scienceright, following professional standards. The alternative - drifting in a sea of anecdata - would yield few useful results.

That's the positive side.  However, objectification is no fun at the receiving end.  How many people as soon as they go to a hospital, are made to suffer small indignities, and can have small pieces of their identity stripped away?  How many people all of a sudden stop being "Mr. So-and-So," or "Mrs. So-and-So," or "Dr. So-and-So," and become Jon, Ellen, and Fred while all the doctors retain their professional identities and titles?   And this objectification can lead to even greater abuses:
... [P]regnant women in early-twentieth-century Germany were... paraded naked in front of a whole auditorium full of observers while in labor. American obstetrics was no better: Women were strapped down while in labor and knocked out, whether they wanted it or not.  

And so the person with tzara'at is objectified.  He loses his personhood, becomes an object, is subject to procedures and requirements that are placed on him, and only regains his humanity when he starts to become pure. 

His return to personhood is brought out strikingly when one contrasts the end of Tazria to the beginning of Metzorah. Tazria ends on this note: "This is the law of the spot oftzara'at..." (13:59) - it is the laws of spots.  Metzorah opens thusly: "This is the law of themetzorah on the day that he becomes pure..."  (14:2).  No longer are we dealing with the spot, the disease, but rather with the metzorah, the person.  Now, it is true, that he is still at the beginning of becoming better, so "... and he shall be brought to the Kohen." (ibid.).  But once the Kohen determines that he has healed, this person becomes a full actor, "And the Kohen shall command to take for the one purifying himself..." (verse 5).  He is not being purified, he is purifying himself.  And finally, "And the one purifying himself shall launder his clothes, and shall shave his hair, and shall bathe in water, and shall be pure, and then he shall come into the camp..." (verse 8).  He is reentering society and is no longer "sick," and has now become once again a person and an actor.

The Torah is describing the somewhat inevitable objectification that occurs in a patient-doctor relationship.  But can this situation be rectified?  Can we retain the objectification necessary for good medicine and good science, but not lose the humanity of the person in the process?   In contemporary medicine, there have been some improvements in this area:

Over the past 40 years, under pressure from consumer advocates, feminists, and medical ethicists, medical researchers and practicing doctors have become a lot more sensitive to problems of objectifying patients. Patients with cancer are no longer kept ignorant of their diagnosis and prognosis. These days, expectant mothers are often encouraged to write birth plans...  One index of objectification is condescension... [a]nd personally, I've seen a major decline in patronizing attitudes among medical practitioners.

A similar restoring of personhood of the metzorah can be found in Hazal.  Hazal state, for example, that because of the mitzvah "Guard yourself regarding the spot of tzara'at" (Devarim 24:8) that a person is not allowed to cut off a spot that might be tzara'at and is required to show it to a Kohen (Makkot 22a).  This transforms the person into an agent!  The person is no longer being brought to the Kohen, he is bringing himself.  Similarly, the Rabbis famously interpret the verse, "On the day it will be shown to the Kohen" (Vayikra 13:14) as follows: "There are days that he (the Kohen) may see and days he may not see.  From here they said: A groom who has a spot is given the seven days of the wedding feast [before he has to show it to the Kohen]... And similarly, during a Festival, he is given the seven days of the festival" (Moed Katan 7b).  This person is no longer just an object.  He is a person, with an entire life that exists outside of the clinical context, and the Kohen has to be sensitive to these realities, to the person in front of him, before he can decide how or whether to proceed.  Just like, one may add, when doctors see the full person in front of them, and not just the condition, they listen better, inquire more, contextualize more and are more able to render the correct diagnoses.

We can learn a lot from this necessary balancing act.  Let us always strive to give the best judgment that we can of others and of others' work when that is what is asked of us.  But at the same time, let us never forget the humanity of the person, that we are dealing with an actor and an agent and that we must engage that person as such, even when in our most professional and objective mode.   And certainly if a person is ill must we be sensitive to this.  For not only does the path to recovery allow a person to regain his or her humanity, but it is the regaining and retaining of that humanity that allows for recovery to begin.

Shabbat Shalom!  

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