Thursday, June 28, 2012

Metaphor and the Misheberach

“It is diseases thought to be multi-determined (that is, mysterious) that have the widest possibilities as metaphors for what is felt to be socially or morally wrong.”
                                                                                                --Susan Sontag

In 1977, two years after being diagnosed with breast cancer, Susan Sontag published Illness as Metaphor—not a personal account of her experience, but rather an examination of the ways our culture layers meaning onto illness in the metaphors we use to discuss it. The less the causes of illness are understood, the more likely it is to be seen in aesthetic terms (as TB was in the 19th century) or as a product of our grief, anxiety, or repression.

In the ancient world, diseases, particularly infectious ones, were always a sign of social wrongs—an answer to immoral behavior. The plague upon the city in Oedipus Rex, for example. Plagues were viewed as a divine punishment and purifier.

We can see examples in the Torah of this same thinking, even regarding individual afflictions. We like to cite “El na refa na la” as a prayer for healing (it has such lyrical brevity), but we tend to forget the fact that Miriam is stricken with scaly skin as a punishment for a loose tongue. If we look truthfully at that passage, Moses can only appeal this way for the curse to be lifted because God has cast it upon her. The genesis of this prayer is the view that disease is a punishment for immoral behavior.

As medical science has progressed over the centuries, and we’ve come to understand causes such as viruses and bacteria for scourges from TB to cholera to polio, we have mostly abandoned this way of thinking, although fundamentalists tend to resurrect it in a rather virulent way (witness the AIDS crisis).

Since the time that Sontag wrote this significant essay, we have made enormous strides in our understanding of how cancer works, particularly at the genetic level. But we still lag behind in our cultural understandings, in the way we talk about disease, especially cancer. Metaphors get embedded like fossils in our language. Since the causes of cancer are numerous and complex, and since it starts from within our own cells, it retains enough mystery that all manner of ideas can be applied to it. As Sontag writes, “Theories that diseases are caused by mental states and can be cured by will power are always an index of how much is not understood about the physical terrain of a disease.”

So, for instance, when you visit practitioners of alternative or complementary therapies, some of which can be very effective for managing side effects or the general stress and fatigue of treatment, you can often still be faced with attitudes that are a throwback to the idea that cancer comes from repressed emotions or desires. My massage therapist, otherwise a total godsend in my mind, suggested that because I used to want a breast reduction, that it was not a coincidence that breast cancer “manifested” itself. Other therapists have asked me what I think caused this, as though a childhood trauma or bout with depression were the answer. And there is all the talk about “blocked energies.”

All of which feels as punitive as the ancient idea that immoral behavior produces disease. It puts the blame on the patient. Not to mention the onus of curing oneself of one’s negative feelings or desires right at a time when even the most stable among us are prone to being fragile. 

Cancer is not a “shame,” not a “battle,” not a “curse,” not a “manifestation” of bad thinking, and these ways of thinking are only obstacles to finding this healing. As Sontag puts it, “the most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, most resistant to, metaphoric thinking.” Not having a scientific view of the disease leads to chasing elusive cures.

I understand well the critiques of the “Western medical establishment” and the way that it has typically focused so intently on producing the absence of disease, which is not the same thing as health and well-being. But I am also in absolute awe of what they can do: the images of the body’s interior, the precision of surgery, the constant elaboration of new, better, more potent, and more targeted drugs. I think complementary therapies, such as acupuncture, massage, and meditation, as well as good nutrition and exercise can also be powerful in bringing one wellness, relaxation, relief from symptoms, and a powerful way of visioning a healthful future. Being part of a strong community, feeling oneself held by others, feeling the directed intentions of people praying for you, is also invaluable in my estimation to regaining wholeness.

I say all this as a prelude to recognizing the inherent genius in the Misheberach, the prayer for healing that we include in daily minyan and Shabbat services. The Misheberach asks for “refuat ha nefesh v’refuat ha goof”—the healing of the soul and the healing of the body—recognizing inherently that the two are distinct and both necessary. One’s physical condition may be incurable, even terminal, but one can arrive at a state of peace and acceptance, even joy nevertheless. Alternatively, I know plenty of people who are “cured” from a medical standpoint, but who cannot recover their equilibrium; they face depression and post-traumatic stress disorder whenever they must face a new test. Healing and wholeness require both a physical and an emotional/spiritual component.

I’ve had many people in the last weeks and months tell me they are saying a Misheberach for me—some I know well, some hardly at all, friends of friends or colleagues of Micah—and it is very intense to think of the directed kavanah of so many people near and far, from San Francisco and Los Angeles to Jerusalem and even Tzfat. What are we praying for when we pray the Misheberach?

I would venture to say we are certainly not asking God to lift a punishment. Many of us probably also struggle with the idea of petitionary prayer in general—the idea that we can request specific things, for one person to be healed over another. But as Bill Cutter says in an article on the topic: “We may not believe that God will choose to make a Jew in Pittsburgh well, while ignoring a little girl in India; but we know how we hope when our backs are against the wall.” More than that even, the prayer reaches out to others in our community—it engages our involvement, it implicitly asks us to act, to visit the sick, to support the caregivers—it is a call to awareness when we are well that we not be smug and indifferent; it is a call to compassion as well as action.

Here is one translation of the Communal Blessing for Healing:

May the One who was a source of blessing for our ancestors, bring blessings of healing upon [insert name here], a healing of body and a healing of spirit. May those in whose care they are entrusted be gifted with wisdom and skill, and those who surround them be gifted with love and trust, openness and support in their care. God, let your spirit rest upon all who are ill and comfort them. May they and we soon know a time of complete healing, a healing of the body and a healing of the spirit, and let us say, Amen.

What I like so much about this version in particular is how it acknowledges that illness is not an individual affliction—it ripples out to touch so many, and the family, friends, caregivers, and community of the ill also need care, “wisdom and skill” but also “love and trust.” Trust is a doozy. I love that this prayer inherently recognizes the many facets of healing—the soul and the body, the individual and the community—and that it reaches towards that elusive thing “refuah shlemah,” a complete healing. Getting there requires both science and spirit--but hackneyed metaphors, not so much.


  1. Refuah shleimah, to be sure, Erin, but also kol hakavod! Thanks for the beautiful and insightful essay.

  2. Thank you for the Rabbi Lew saying, "The truth is that our lives are a constant flow, utterly devoid of stopping places." That opens my mind up to an exciting conceptualization of life and gives a vivid container for what you are going through. Blessings to you :)

    (Judy E. here. I can't figure out how to get the right Google account name inserted here. I hope Peace will bless your health and being.)