Traditional Jewish Healing in Theory and Practice

By Rabbi Avraham Greenbaum


Rebbe Nachman and the Doctors

Chapter 14

Redemption of the Soul

After having been immersed in Rebbe Nachman's profound and moving teachings about simchah and healing, his emphatic warnings against doctors may seem almost jarring. He urged his followers to avoid medicine even in cases of serious illness. He said that the majority of doctors have no understanding of the art of healing. Being far more likely to cause damage than to do any good, most doctors are nothing but agents of the Angel of Death (Rabbi Nachman's Wisdom #50, see next chapter).

Many people find these views shocking and disturbing. Anyone who has had some bad experience with the medical profession is liable to laugh at and complain about doctors. But when illness strikes, God forbid, how could Rebbe Nachman apparently rule out medicine altogether? Even if we accept the paramount importance of repentance, charity, prayer and joy when facing illness, doesn't the rejection of medicine contradict one of the most basic tenets of Judaism - that we must do everything possible to protect and extend human life? Failure to treat illness could cause irreperable damage and actual loss of life, not to mention untold pain and suffering, both to the sick and to those around them!

These issues involve matters of life and death, and they must be considered with the utmost care and seriousness. It is not our purpose here to determine whether people should or should not receive medical treatment. Every present-day halakhic authority would rule unequivocally that in our times a sick person is duty bound to consult a competent doctor and must not rely on being healed miraculously. In the words of the TaZ (Rabbi David ben Shmuel Halevi, 1586-1667), one of the most important commentators on the Shulchan Arukh: "It is a positive obligation and a mitzvah to turn to the doctor at a time of sickness, and the Torah itself accepts that healing can come about through natural means. For the Torah penetrated the innermost recesses of man's mind and knows that his merit will not be sufficient to enable him to be healed through a miracle from heaven" (Turey Zahav on Yoreh Deah #336, and see Birkhey Yosef ad loc.).

No one should use Rebbe Nachman's warnings against doctors, or any other comment in this book, as a rationalization for avoiding necessary medical treatment. People have all kinds of fears about doctors and medicine, and some hold back from consulting a doctor even when they really need to. Even those who do go to doctors often neglect their advice and fail to complete the full course of recommended treatment. This can be highly dangerous. Anyone who has questions or doubts about medical advice they have been given, or about treatment they are undergoing, should consult authorities in the field. Any related religious or spiritual questions should be discussed with a competent rabbi.

Our purpose here is to investigate Rebbe Nachman's various statements about doctors and medicine in order to gain deeper insight into his own healing pathway. His opposition to medicine is founded on his basic standpoint that bodily illness reflects a flaw on the spiritual dimension. Only when the spiritual flaw is rectified can physical healing come about. To try to cure bodily problems with medicines alone is to misunderstand the meaning and causes of physical illness, which is intrinsically bound up with the maladies of the soul. Spiritual healing, far from being merely an "extra," is the very essence of healing.

Rebbe Nachman's attacks on doctors are well-known. Yet he also made numerous other statements indicating that he himself saw a place for medical treatments. As we will see in the course of our study, he recognized that medicines have the power to effect changes in bodily functioning. He himself recommended vaccination as a preventive procedure, and he accepted that at times doctors are in fact able to cure sickness.

Perhaps Rebbe Nachman's warnings against doctors and medicine should be seen not so much as an attack on medicine per se as an attempt to shake people's blind faith in its powers. Since God is the true Healer, to put all one's trust in the doctor and his treatment is misguided. Indeed, waiting for a complete cure through passive submission to medical treatment may actually impede genuine, long-term healing, if it becomes a way of avoiding confronting the personal issues and other problems that so often lie at the roots of physical illness.

 1. Why do people get sick?

The appropriate way to treat illness depends in large measure on what is deemed to be its cause. In the following brief teaching, "Why do people get sick?" Rebbe Nachman gives a general answer to the question of why people become ill.

"When a person fails to focus on the ultimate purpose - the תכלית  (takhlit) - what is the point of his life? The soul constantly yearns to do the will of her Maker. When she sees that this person is not carrying out His will, she becomes filled with yearning to return to her Source, and she prepares to leave the body. As a result, the person becomes sick, because the power of his soul is weakened, owing to the fact that she is trying to withdraw from his body since he is not carrying out her desire. The soul's only wish is that he should carry out God's will.

"The reason a person's health returns through taking medicines is that his soul sees that he is able to control himself and to act contrary to his physical desires and habits. Perhaps he is accustomed to eating bread and other foods, but now he curbs his desires and submits to a medical regime, taking bitter medicines for the sake of his health. His soul sees that he has the power to control his impulses in order to achieve a certain goal, and she therefore comes back to him in the hope that he will curb his desires for the sake of the true purpose - which is to carry out the will of the Creator" (Likutey Moharan I, 268).

Underlying this teaching is the idea that the health and vitality of the body depend entirely on the soul. The soul is the vital core which animates the body. If the body is sick, it is because the soul's power to vitalize it has been weakened, leading to deterioration and malfunctioning of the physical system. Conversely, if the body recovers, it is because the soul's power is restored.

Rebbe Nachman is teaching us that the very key to health and healing lies in a driving will to live - a courageous embrace of life in this world as a magnificent opportunity to develop one's soul to the fullest and strive for an ever deeper connection with God. This is the purpose for which the soul is sent into this world of challenge. When we rise to the challenge and fight to elevate ourselves spiritually at all times, our souls thrive and radiate, sending us a flow of glowing health and vigor. However, when a person mistakes the meaning of this world and goes after its "false grace and vain beauty," this merely thwarts his holy soul. Every step he takes in his pursuit brings another flaw into the soul, separating her from God and taking her further from her true goal. To "cut her losses," as it were, the soul seeks to withdraw from the body and begins to pull away. And with its life-force weakened, the body deteriorates and becomes sick.

It would be wrong to look upon this brief teaching as a general theory of illness, and to question its validity on account of the numerous exceptions that might be found. Many people are obviously far from the spiritual purpose of life, yet seemingly enjoy robust good health (though the Rabbis teach that their vitality comes from the sitra achra, the "unholy side" of creation). As to why people become sick, this is such a broad question that there could never be a single, all-encompassing answer. The human body is so complex and finely-tuned that it is prone to a vast range of ailments and illnesses, depending on all kinds of factors, internal and external. To attribute all the different things that can go wrong in babies, children, adolescents, young adults, the middle- aged, the old and the very old to a single factor would clearly be ridiculous.

Various statements in Rebbe Nachman's writings indicate that he fully grasped that there are many different kinds of illnesses. He discusses terminal illness (Likutey Moharan I, 250), congenital and noncongenital illnesses (ibid. II, 1:11), infectious diseases (Tzaddik #459) and conditions caused by factors such as dietary abuse, anxiety and tension (Likutey Moharan I, 263, see p. 428; ibid. 23:5). As we have seen, Rebbe Nachman faced illness and tragedy in his own life and in the lives of his immediate family, and he knew that many cases of illness and death are bound up with deep mysteries of God's providence.

Nevertheless, numerous cases of physical illness are clearly linked with what is happening in the minds and hearts of those afflicted - from the colds and infections that develop at times of particular stress, to far more serious conditions such as heart disease, certain cancers and other problems. Much has been written in recent years on the connection between a wide variety of physical conditions and important events and developments in the lives of the patients, their outlooks, attitudes and personalities (see Norman Cousins, The Healing Heart; Bernie S. Siegel M.D., Love, Medicine & Miracles and Peace, Love & Healing).

Rebbe Nachman's teaching on "Why do people get sick?" provides a powerful approach with which to penetrate to the very core of the inner crises that so often lie at the roots of such conditions. The conscious or unconscious feelings of anxiety, frustration, meaninglessness, grief and despair involved in many different illnesses are all essentially bound up with the broad loss of purpose to whichRebbe Nachman refers. The rediscovery of meaning and personal mission - the will to live - has time after time proven to be the single most important factor in people's long-term recovery from all manner of serious, life-threatening conditions.

Even in the case of more minor ailments - colds, 'flu, rashes, digestive upsets, allergies, etc. - Rebbe Nachman's teaching implies that sometimes people may be afflicted because the pressures in their lives have deflected them from their purpose, weakening their soul-powers and thereby disrupting their physical balance and lowering their immunity. An important element in recovery may be to take the time to recommit oneself to one's highest goals and seek more effective strategies for attaining them.

Missing the mark

The Rabbis taught that the main reason why illness strikes is because of sin. "There's no suffering without sin, as it is written (Psalms 89:33), `I will requite their transgressions with the rod and their iniquity with plagues'" (Shabbat 55a). "If you see a Jew with one of the four signs of leprosy mentioned in the Torah, its only purpose is to heal him of all his sins, and through his suffering he attains the life of the World to Come" (Tanna devei Eliahu 5). "Rabbi Acha said, It is up to the individual himself not to be afflicted with illness, as it is written (Deuteronomy 7:15), `And God will remove from you all illness.' That is, protection from illness comes from you - from the individual himself. R. Abin said, What you must protect yourself from is the evil urge, which is sweet at first but bitter in the end" (Vayikra Rabbah 16:8).

Once a man came to the Ari and said that for two days he had been suffering intense pain in his shoulder. The Ari looked at him and said the reason for the pain was that instead of reciting the Grace after Meals directly after washing his hands at the conclusion of his meal (mayim acharonim), he had paused to study some Mishnah. The Rabbis said, "Recite the blessing directly (teikhef) after washing" (Berakhot 42a). TeiKheF, had turned into KaTeF), a "shoulder," and this was why he felt the pain in his shoulder (Shaar HaMitzvot, Ekev p. 60).

Explicit statements by our Sages must be accepted with the utmost respect. At the same time, it is a fact that some people find the suggestion that illness results from sin to be disturbing and even offensive. The distress and anxiety suffered by those confronting serious illness are painful enough. Is it not cruel and heartless to compound them by suggesting that the sick person is responsible for his own suffering and should feel guilty about it? Why should the patient be burdened with fear and guilt at a time when he most needs sympathy, kindness and support? Surely the idea that sin is the underlying cause of illness is more likely to hinder the healing process!

Rebbe Nachman well understood that many people experience nothing but negativity and depression when thinking about sin, and he knew how damaging these can be. While he leaves us in no doubt whatever that sin and evil actually do exist and that we must try our utmost to avoid them, he also recognized that when a person has already sinned, it is counterproductive for him to sink into gloom and self-recrimination. "The reason most people are far from God is that they become demoralized when they see how destructive their behavior has been, and they fall into depression and sadness. One must use one's intelligence to fight against this, because low self-esteem is worse than anything. It is true that the person actually committed the wrongdoings that cause him to experience this demoralization. But the demoralization and depression themselves are nothing but the work of the Evil One, who wants to weaken his resolve and cast him down completely" (Likutey Moharan I, 282).

The last thing Rebbe Nachman would have wanted is that we should let our sins drag us into depression and despair. Yet he wanted us to recognize the truth, that illness may be caused by sin. He mentions this idea in several places (e.g. Likutey Moharan I, 4:5; ibid. II, 8:6 etc.). He did not want people to allow their distaste for uncomfortable guilt feelings to blind them to the truth. On the contrary, he urged us to confront our sins and transgressions directly, to the point of taking time each day to examine our behavior and activities and feel contrition for our mistakes. This is an integral part of hisbodedus, and careful introspection and wholehearted acknowledgement of past mistakes for what they are can be a most important part of the healing process.

Rebbe Nachman's teaching on "Why do people get sick?" can be seen as a restatement of the rabbinic teaching that illness is bound up with sin, clarifying the essential truth the Rabbis were expressing while avoiding the clouds of negativity and depression associated with the idea of sin in the minds of many people. The Hebrew word חטא  (chet), usually translated as "sin" or "transgression," has the root meaning of "lacking" (cf. Kings I, 1:21), or "missing the mark," as in archery, when a person is aiming for a certain target but misses (cf. Judges 20:16). The purpose of our lives in this world is to attain the ultimate good through carrying out the positive mitzvot, which bring us to ever deeper attachment to God. This is our takhlit, or "target." If we turn aside from it, we "miss."

When we do, we ourselves are the losers. Each person has his or her own individual takhlit - a unique pathway of connection with God - as well as the particular constellation of obstacles that constitute his or her unique challenge in this world. Perhaps the worst chet in life is to fail to fulfil one's personal mission. In the famous words of Reb Zusya of Anipoli (d. 1800), "On the day of reckoning, when they ask me, `Why weren't you like Abraham, Isaac and Jacob?' I won't be afraid. But when they ask me, `Why weren't you like Zusya?' - that's when I'll be afraid." In his teaching on "Why do people get sick?" Rebbe Nachman is telling us that to allow ourselves to veer from our true mission in life is not only a deep spiritual flaw; it is also a direct threat to our actual physical health.

"The sins are inscribed upon the bones"

Rebbe Nachman taught that "a person's sins are on his bones, as it is written (Ezekiel 32:27), `And their sins were inscribed upon their bones'" (Likutey Moharan I, 4:5). Immediately prior to giving this teaching, Rebbe Nachman told the following story:

One of the Baal Shem Tov's followers was very sick, and sent a messenger to the Baal Shem Tov asking him to come. The Baal Shem Tov agreed. On the way, the messenger said to the Baal Shem Tov, "This sick man would seem to have repented completely and he is surely a good Jew. He's not very old yet - so why hasn't he been cured?" The Baal Shem Tov replied, "It is certainly true that this man has repented completely for all his sins. The reason he has not yet been cured is because he has not confessed his sins to a true Tzaddik. My purpose in going to him is to give him the opportunity to do so."

The Baal Shem Tov continued: "If he confesses he will be cured immediately. But if he refuses, his condition will immediately deteriorate. He will start screaming with agony. He'll feel pain in all his limbs, his hands and his feet, and then he'll die. It is true that in the higher worlds not a single sin or transgression will be held against him, because he has repented completely for all his sins exactly the way he should. After his death the forces of evil will have no grip on him at all, seeing that he has rectified all the damage he has done. If he confesses to me, he will be cured immediately. But if he does not, the forces of evil will still have the power to take vengeance on him in this world. They will attack all his limbs until he dies."

And so it was. The Baal Shem Tov came to the sick man and said, "Tell me what you know, and God knows, and I also know" - i.e. he should confess all his sins to him. The Baal Shem Tov said this to him three times. However the man was unwilling to confess. Immediately afterwards he started screaming in agony. He felt pain in each limb in turn, and he cried out bitterly. The man carried on screaming like this until he died, as the Baal Shem Tov predicted (Tzaddik #184).

If illness strikes, God forbid, medical treatment may help. As Rebbe Nachman says in "Why do people get sick?" the self-discipline involved in following a medical regime may pave the way for the soul to shine into the body again and so bring about a cure. (The same could be said to apply to all healthful practices, such as careful diet and regular exercise, which many find to greatly enhance their spiritual as well as their physical well-being.) But even when receiving treatment, it is vital to bear in mind that the essential work of healing is not so much to take the medicine as it is to make sincere efforts to stir ourselves spiritually. We must ask ourselves: "Where in the world am I? What have I been doing with my life? What is my ultimate purpose and how can I attain it?" Many people want to leave all the work to the doctor: "Do something - anything! Just cure me!!!" But there can be no true healing without a movement to teshuvah on our part - a return to our own true mission.


"One should ask people `What?' People don't think about their purpose in life. What? After all the frustrations and distractions, after all the complaining and all the empty excuses you give for being far from God, when everything is over, what is going to be left of you? What are you going to do in the end? What will you answer the One who sent you? What are you if not a visitor on this earth? Life is vanity and emptiness, a passing shadow, a vanishing cloud. You know this. What do you say? Place these words on your heart. Bring them into the depths of your being. Don't ignore them. Turn them over and over and you will save your soul" (Rabbi Nachman's Wisdom #286).

2. License to Heal?

The essential first step in bringing about a cure is פדיון נפש  (pidyon nefesh), "redemption of the soul." The forces that cause people to veer from their true purpose in life often lock them in more strongly than prison bars. When a person falls into some kind of chet (transgression), his soul-powers are taken captive, as it were, by the impure forces nurtured by the chet. It may be impossible for him to free himself, because "a prisoner can't release himself from prison" (Berakhot 5b). The sick person needs someone with sufficient spiritual power to redeem his soul from its captivity. This is the true Tzaddik, who intercedes on behalf of the suffering individual, opening the way for a cure.

Pidyon nefesh, "redemption of the soul," is the main theme of Rebbe Nachman's teaching of the same name (Likutey Moharan II, 3). The essential idea is that only after pidyon nefesh has been accomplished does the doctor have the power to cure the patient. This teaching was probably given in the winter of 1808-9. By then Rebbe Nachman was seriously ill with tuberculosis, and he may have been alluding to his own illness in the opening words of the teaching, which refer to the mishnaic Sage, Rabbi Eliezer the Great. As the towering Tzaddik of his generation, Rabbi Eliezer had the power to accomplish pidyon nefesh for others, yet he was unable to do so for himself when he was sick.

"Redemption of the Soul" was taught during the period when Rebbe Nachman was most outspoken against doctors. Yet the Talmud states explicitly that "the Torah gave the doctor license to heal" (Berakhot 60a). On the face of it, this would seem to be a clear statement that doctors have been given the power to cure illness! But according to Rebbe Nachman, the true meaning of this statement can only be understood in relation to another saying of the Rabbis, that a sick person can only be healed "by a particular drug and a particular man on a particular date" (Avodah Zarah 55a).*

*The talmudic statement that healing can come about only "on a particular date, through a particular drug and a particular doctor" (Avodah Zarah 55a) comes in the context of a discussion about why sick people who go to idolatrous healing shrines (which were common in Graeco-Roman times) come away cured:

"Zonin said to Rabbi Akiva, `You and I both know in our hearts that idols are totally powerless. Yet we see that people go into idolatrous healing shrines virtually crippled by their ailments and they come out healthy! Why?' Rabbi Akiva replied, `Let me explain it with a parable. Once there was an honest man to whom all the townspeople used to entrust their valuables for safekeeping without witnesses. But there was one man in town who always made a point of depositing his valuables in front of witnesses. Once it happened that this man forgot, and he placed a deposit without witnesses. The wife of the man guarding the goods said to her husband, `Let's deny that he deposited these goods and keep them for ourselves.' But her husband replied, `Just because this fool acted improperly, does that mean we should throw away our honesty?' So it is with suffering. When suffering is sent to a person, the agents inflicting it are bound by an oath: `Come to him only on a particular day, and don't leave him except on a specific day at a given hour, through a particular doctor and a particular medicine.' When the time comes for the suffering to end, the sick person goes to an idolatrous healing shrine. At first, the agents inflicting the suffering say, `By rights we should not let go of him [because he will attribute his recovery to his idol].' But then they relent, saying, `Just because this fool has acted improperly, does that mean we should break our oath?'" (Avodah Zarah 55a).There may be a subtle humor in Rebbe Nachman's reference to this talmudic passage in his discussion of the doctors' license to heal. Rebbe Nachman saw something idolatrous about the way people put their faith in medicine, as if without medicine God does not have the power to heal (Likutey Moharan I, 62:6). Interestingly, even some prominent contemporary doctors also look upon modern medicine as a form of idolatry. In the words of Robert S. Mendelsohn M.D., Associate Professor in the Department of Preventive Medicine and Community Health, Abraham Lincoln School of Medicine, University of Illinois:

"Modern medicine is the religion of a secular society that has rejected its traditional value systems. Modern medicine has at least ten of the essential components of a religion: (1) A belief system, modern medical science, which can no more be validated than the proofs of other churches... (2) A priestly class - the M.D.'s. (3) Temples - the hospitals. (4) Acolytes and vestal maidens - nurses, social workers and paraprofessionals. (5) Vestments reflecting hierarchical status - the color and length of M.D.'s gowns signify their rank. (6) A rich princely class supporting the church - drug companies, insurance companies and formula houses. (7) A confessional - the history must be given truthfully to the physician. (8) An absolution - the reassuring pat on the back - `You're fine, come back next year.' (9) Selling of indulgences - the outrageous fees, likely to bring down this modern church just as it did the medieval church. (10) Similarity of language - I have confidence in my plumber but `I have faith in my doctor'; the doctor-patient relationship is `sacred.' Unfortunately, the religion of modern medicine proves to be worship of a god who fails to answer, who is powerless and who, in fact, deceives. This, of course, is the definition of idolatry..." (from Dr. Robert S. Mendelsohn's Foreword to Natural Healing through Macrobiotics by Michio Kushi, 1992).


Redemption of the Soul

Likutey Moharan II, 3

"When Rabbi Eliezer the Great became sick, he said to Rabbi Akiva, `There's fierce anger in the world' (Sanhedrin 101a) - for there was no one with the power to sweeten the harshness of the judgment. In order to sweeten the decree, a פדיון  (pidyon), redemption, was needed, but it was not forthcoming. After the decree is sweetened through a redemption, the sick person can be cured with medicines, because after the redemption and sweetening of the judgment, `the doctor has license to heal,' but not before.

"For how can the doctor really undertake to cure the patient with herbs and drugs? He doesn't know which drug is needed to heal this particular patient! There are many drugs which have the power to cure the illness, but unquestionably this particular patient will not be able to be cured except by the specific drug which has been designated to cure him by divine decree. For as our Rabbis taught, it is decreed in Heaven that the sick person will be healed `by a particular drug and a particular man on a particular date' (Avodah Zarah 55a). If so, how can the doctor undertake to cure the patient? He doesn't know which drug was decreed in Heaven!

"But after the judgment has been sweetened through a redemption, the doctor has the power to effect a cure. For the reason why the patient has to be cured by a specific drug and a specific doctor is because of the attribute of strict justice, which decrees that the illness must last for a given length of time, ending on a particular date. This is why it is decreed that the patient can only be cured by these means - the specific drug and doctor - in order that the illness will continue until the given date. According to the required duration of the illness, so it is decreed how it is to be cured, to ensure that it will not be cured until the necessary conditions are at hand - the particular drug and doctor - so that the patient will not be cured until a particular day.

"However, when a redemption is made and the judgment is sweetened, the decree is canceled. In the interval before another decree is passed (for when one judgment is sweetened, another decree is passed), after the sweetening of the first judgment and before the imposition of a new decree, the doctor has the power to heal the sick person with drugs. For at that moment there is no judgment, and the patient can be healed by any medicine: there is no need for a particular drug, etc. since no decree is currently in force. Thus we see that it is impossible for the doctor to heal without a redemption. First a redemption must be brought about in order to sweeten the decree, and then the doctor has license to heal.

"For this reason the numerical value of the letters of the Hebrew words רפא ירפא  (RaPO YeRaPE), `he shall cause him to be thoroughly healed' (Exodus 21:19), with the addition of two units for the two words themselves, is 574. This is the same as the numerical value of the words פדיון נפש  (PiDYoN NeFeSh), `redemption of the soul' - because essentially the cure comes about through the redemption, through sweetening the decree. This explains the statement of the Rabbis that `it is from here that the Torah gave the doctor license to heal' (Berakhot 60a). From here - i.e. from this point on, after the redemption. For before the redemption the doctor has no license to heal, because the patient can only be cured by a particular drug, etc. It is only after the redemption brings about a sweetening of the decree that the doctor has license to cure."


Captivity and freedom

Rebbe Nachman's essential point in this teaching is that the true meaning of the rabbinic dictum that "the Torah gave the doctor license to heal" can be understood only in relation to the talmudic teaching that the sick person is healed "through a particular drug and a particular doctor on a particular date" (Avodah Zarah 55a). This second statement of the Rabbis defines and limits the extent of the doctor's license to heal.

Illness is seen as a heavenly decree, a "judgment." Unless the decree is mitigated through pidyon nefesh, redemption of the soul, the illness will run its course, and only when its required duration is complete, as laid down in the decree, will the patient recover. In order for the illness to continue until a particular day and hour, the decree governs the very means by which the patient will eventually be cured: through "a particular drug and a particular doctor." Thus if the doctor has "license to heal," it is only as Heaven's agent to release the patient from the decree of illness when its duration is complete. The doctor is like a prison warden who is given the key to open the cell only after the sentence has run its course. The only other circumstance in which the doctor has license to heal is when the decree against the patient has been revoked or mitigated through pidyon nefesh.

Rebbe Nachman's response to the objection that many people receive medical treatment and recover is that the treatment itself is an incidental factor. The essential reason why the patient recovers is that the decree has reached its end, and therefore a heavenly-ordained chain of events ensures that his body heals. On the other hand, as long as the heavenly decree is in force, no matter what the patient or the doctors may try, nothing will avail. This would explain the common phenomenon of patients who wander from doctor to doctor in search of a cure, but nothing seems to help - until one day, often unexpectedly, a cure comes about through some quite simple remedy, or even spontaneously.

One of the main reasons Rebbe Nachman gave for his opposition to medicine is that even the most outstanding doctors are unable to take account of all the variables involved in illness in order to determine the appropriate treatment (Rabbi Nachman's Wisdom #50). The concept of illness as a decree may help explain this. It is as if perfect understanding of the divinely created human body and its ailments has been withheld from humanity by design in order to ensure that no one will be able to overturn God's decrees through natural means until the heavenly appointed moment arrives. This could explain why, as medical science has uncovered cures for certain diseases, other scourges have appeared to take their place (see Rabbi Nachman's Wisdom #291). "Many are the designs in man's heart, but God's counsel will prevail" (Proverbs 19:21).

Indeed, far from having the power to circumvent God's decrees, Rebbe Nachman said that doctors themselves are at times cast in the role of the agents sent to impose them (Siach Sarfey Kodesh I-655). A medical diagnosis is really nothing but a hypothesis about a person's physical condition - a hypothesis that may or may not be accurate. But not infrequently, medical diagnoses turn into self-fulfilling prophecies. Labels like "cancer," "heart disease," "multiple sclerosis" and the like naturally tend to produce panic in patients, often leading to a sense of helplessness and depression that can itself cause a deterioration in their physical condition.

For many patients, medical treatment and all it involves can turn into a harsh decree that throws a terrible shadow over the whole of life. Even the quality of the doctor's human relationship with his patient - his sensitivity, kindness, warmth or the lack of them - can have a decisive effect on the course of illness and recovery, as is recognized by many psychologists and growing numbers of doctors.

Mitigating the decree

People turn to doctors in the hope that medical intervention will effect a cure. But Rebbe Nachman is teaching us that, as long as the decree of illness is in force, the only form of intervention that can bring about a true change in the situation is pidyon nefesh, a redemption that mitigates the decree. What exactly is a "redemption"?

According to Torah law, when a person has been captured or kidnapped and his captors are demanding a ransom, it is a mitzvah for his fellow Jews to pay to release him (Shulchan Arukh, Yoreh Deah #252). This is known as פדיון שבויים  (pidyon shevu'im), "redemption of captives." The concept of "redemption of the soul" implies that the soul is in captivity. Just as a person may literally be held in physical captivity, so there are times when he may be "imprisoned by circumstances" through a heavenly decree. There may be no actual physical bars or chains, but the troubles and difficulties people are sent in life - family, emotional, financial and many others - can be quite as painful and limiting as actual incarceration, if not more so. In the Torah view, illness is such a decree.

Rebbe Nachman said that all the suffering people go through is sent either to arouse them to repent or to cleanse them of their sins (Likutey Moharan I, 65:3). Just as the length and severity of prison sentences may vary according to the offense, so every heavenly decree is measured with the utmost exactness, taking all the relevant factors into account, for the ultimate benefit of the soul that is suffering - for "God is righteous in all His ways and gracious in all His deeds" (Psalms 145:17). And just as most judicial systems include a system of appeals, with specific procedures for requesting clemency in order to reduce or revoke sentences, so does the heavenly system of justice. A prisoner calls upon a respected advocate or intercessor to plead his cause. In the same way, a Jew who sees that he or his dear ones are under the sway of stern decrees turns to one whose merits in the eyes of Heaven will give added strength to his appeal - the Tzaddik.

Thus the Talmud states that "someone who has a sick person in his house should go to a Sage and ask him to pray for him" (Bava Batra 116a). When a Jew is sick or in some other kind of trouble, it is customary for the suffering individual or those acting on his behalf to bring a sum of money to a Tzaddik and ask him to pray in order to bring about a pidyon nefesh. The money - often called the pidyon - is like a ransom paid to free the soul from its "captivity." The Tzaddik places his hands on the money and prays, after which the money is distributed to the poor.

In any appeal system, the intercessor will either plead mitigating circumstances or show evidence that the prisoner has undertaken to reform, making further punishment unnecessary. Since illness is sent either as a prompt to repentance or to cleanse one of sin, if the sick person does indeed repent and starts to make amends for his sins, this in itself may open the way for him to be healed. The two concepts involved in pidyon nefesh - charity and the Tzaddik - are both bound up with repentance.

Money is something for which people are willing to sacrifice their lives and their very souls. Money can be used to gratify man's basest lusts or to realize his highest ideals. The craving for wealth drives people to some of the worst sins - dishonesty, corruption, theft, robbery, exploitation and many others. Yet honestly acquired money can be used to reveal Godliness in the world and spread kindness and goodness - through giving charity to those in need, supporting Torah institutions, financing the publication of Torah works and carrying out other mitzvot.

When a sick person takes his precious, hard-earned money and brings it to the Tzaddik, it is like a latter-day sacrifice. His material wealth is elevated and becomes spiritualized. In addition, by breaking his instinctive selfishness and insensitivity in order to practice charity, he creates a vessel in which to receive God's love and kindness. Charity has the power to reveal the Supreme Will of God, which is beyond the laws of nature and controls the entire world: God has the power to send healing through any means He chooses, even in an instant! (Likutey Moharan II, 4).

A man once came to Reb Noson and asked him to pray for him, giving him a ruble as a pidyon. Without even waiting for an answer, the man left, but Reb Noson called him back, saying, "Do you remember such and such a time when you were in trouble and you promised God you would repent. God helped you and you were saved, but you didn't start serving Him properly." Reb Noson went on to list the times the man had been in trouble and said he would repent. "And now you're in trouble once more and you come to ask me to pray for you again? What am I - your hired help? I should pray and then you'll return to your evil ways? The main reason why all this is happening to you is so that you should truly repent!" (Siach Sarfey Kodesh 1-700).

The Tzaddik is the exemplar of Godly living. The very act of turning to him for help and guidance is itself an act of repentance. Indeed the Tzaddik is the true doctor - the doctor of the soul. In the words of the Rambam: "What is the remedy for those who are sick in their souls? They should go to the Sages, who are the healers of the souls, and they will heal the sickness through the new attitudes and behavior patterns they teach them, until they return to the good pathway" (Mishneh Torah, Hilkhot De'ot; cf. Likutey Moharan I, 30:2). On one level, the Tzaddik works with the sick person directly, guiding him to make any necessary changes in his life and to rectify the mistakes of the past. On another level the Tzaddik seeks to intercede in the heavenly court in order to "release" the sick person's soul from captivity so that healing may come about.


Rebbe Nachman said: "I do not understand how the tzaddikim claim to make a pidyon, or redemption, and intercede for someone. There are twenty-four heavenly courts [corresponding to the twenty-four permutations of the letters of the name אדני  (ADoNoY) , which is associated with judgment]. When the Tzaddik presents the redemption, he must know in which court the person is being judged. If he does not know this, he may intercede and bring the redemption to one court, while the person is actually being judged in another. [The Rebbe compared this to someone being sued in the courts of Kiev and trying to defend himself in the courts of Kaminetz (Tzaddik #181).] He must therefore know precisely in which court the man is being judged, and what particular intercession and redemption is required by that particular court.

"I know all twenty-four courts. I can appeal a case from one court to another through all twenty-four courts. If I do not agree with the judgment of one court, I can ask that it be rejudged in another. Going from one court to another is certainly beneficial. No matter what the final outcome, the sentence is still set aside and delayed. Owing to this delay, the sentence can be reduced because of some merit on the part of the defendant. Even if this does not help, I can still appeal directly to the King. This takes great wisdom and effort, and no one else in this generation can do it. It is a major task to frame each petition in the precise number of words and to give proper respect to the King. For it is certainly impossible to send too many cases directly to the King..." (Rabbi Nachman's Wisdom #175).


Kabbalistic Intentions of Pidyon Nefesh

Rebbe Nachman taught: "Money is related to strict judgments. Thus it is written, `and all the living substance that was at their feet' (Deuteronomy 11:6), on which the Rabbis commented: `This refers to a person's money, which is what enables him to stand on his feet' (Pesachim 119). From this we learn that money is the `feet.' Now it is written, `Justice attends his footsteps' (Isaiah 41:2), and `Justice is the holy kingship (malkhut)' (Tikkuney Zohar, Introduction), and malkhut is judgment. This indicates that money is related to judgment.

"It is necessary to sweeten the severe judgments at their root, which lies at the level of Binah, `Understanding,' as it is written, `I am understanding, power is mine' (Proverbs 8:14). This is why the Tzaddik places his hands upon the money in order to sweeten the judgments. For there are three `hands' in Binah: the `great hand' (Exodus 14:31) and the `strong hand' (Deuteronomy 7:19 etc.), which together make up the `high hand' (Exodus 14:8). When the money - i.e. the severe judgments - comes to the hands, which allude to the three hands of Binah, the judgments are sweetened at their source.

"The severe judgments have their hold in this world of Asiyah. They must be sweetened by means of the three hands in each of the three higher worlds, Atzilut, Beriyah and Yetzirah. When one sweetens the severe judgment in the world of Asiyah through the three hands in the world of Yetzirah, the judgment is sweetened through the Name of 42 letters contained in the prayer `Ana BeKoach': the numerical value of the Hebrew letters of the word yad, `hand' is 14, and 14 x 3 = 42. In the world of Beriyah the judgment is sweetened through the Names EHYeH and YHV, the numerical value of whose letters also adds up to 42. Higher still, in the world of Atzilut, the judgment is sweetened through the 42 letters of the Name of YHVH, its expansion (MaH) and the expansion of the expansion - altogether 42 letters, three times Yad (14).

"It is most important not to be stingy in the amount of money one gives in order that no severe judgments should remain hovering over one. It takes exceptional wisdom to know exactly how much a particular person should give to make sure that no harsh judgments remain" (Likutey Moharan I, 180).

*   *   *

The Tzaddik places his two hands upon the redemption money and says:

"May it be Your will to sweeten the harsh and severe judgments against (...) the son/daughter of (...) through Pele Elyon, the Supreme Wonder, where there is nothing but utter mercy and complete, simple love with no severity at all. Amen."

Likutey Tefilot p.105




By Rabbi Avraham Yehoshua Greenbaum
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