THE WINGS OF THE SUN
Traditional Jewish Healing in Theory and Practice
Chapter 15
Rabbis vs. Doctors
Rebbe Nachman was far from being the only Torah Sage who expressed opposition to medicine. The Bible itself criticizes King Asa for turning to the doctors in his illness instead of seeking out God (Chronicles II,
There is a famous talmudic statement that "the best of physicians are destined to go to hell" (Kiddushin 82a). In the words of the talmudic commentator, R. Menachem ben Shlomo Me'iri (1249-1316), the reason is that the doctor "does not make enough effort in his work of healing, or at times he does not know the cause of the illness and how to cure it, but he presents himself as an expert and causes the death of the patient" (Me'iri ad loc.). Rashi (ad loc.) agrees that doctors sometimes cause the death of their patients, and he adds that the doctor is unafraid of illness and does not humble himself before God, and also fails to help those who cannot afford treatment.
As we have seen, the Talmud states that "the Torah gave the physician sanction to heal" (Berakhot 60a). However, later rabbinic authorities point out that it does not necessarily follow from this that a Jew who is sick has license to rely on doctors to heal him. The RaMBaN (Rabbi Moshe ben Nachman of Girondi, 1194-1270), who was himself a physician, states in his classic Commentary on the Torah:
"In the era of prophecy the tzaddikim consulted not doctors but prophets. For what place do doctors have in the house of those who carry out the will of God, after He promised that `He will bless their bread and their water, and remove illness from their midst'? (Exodus 23:25) Although the Rabbis said that the physician has been given sanction to heal, this does not mean that license has been given to the sick to resort to medicine! What the Rabbis meant is that if a patient has already come to the doctor, the doctor should not refrain from treating him. But when a person's ways find favor in God's eyes, he has no business with doctors" (Ramban on Leviticus 26:11; for the full text, click here).
The Ramban's view is that the Jewish People were intended to live on a spiritual plane beyond the law of nature and to receive all their needs - livelihood, healing and everything else - directly from the hand of God. Wholehearted devotion to the Torah pathway will itself protect against illness, which, if it occurs, is not a chance occurrence but rather a sign of a flaw in the afflicted person's attachment to God. A sick Jew should seek out not a physician but a moral teacher who will help him repent - the Tzaddik. All of these ideas can be found in Rebbe Nachman's teachings on healing.
Unlike the Ramban, the classical Bible commentator Rabbi Avraham Ibn Ezra (1089-1164) does not reject medicine outright, but he limits its permissibility to external wounds. In his comment on the phrase, "he shall cause him to be thoroughly healed" (Exodus
Explaining Ibn Ezra's view, the Avi Ezer (Rabbi Shlomo HaKohen of Lissa) writes: "Internal illnesses are caused by dietary excesses or climatic changes, but the soul-powers of a person who is attached to God will strengthen his natural heat and bodily fluids, and he will live longer than the normal lifespan. A person can thus heal himself of internal illnesses by binding himself to his soul, which will give him life and bodily health. A person who is attached to God is also granted protection against untimely death from injuries caused by other humans, such as war wounds or a sudden blow from an attacker. But when a person fails to serve God wholeheartedly and believes that other humans are completely free agents and not under God's control, this itself puts power into the hands of his fellow man or his master to strike him, and he must then turn to a human doctor to cure him" (Avi Ezer ad loc.).
Prominent among later Rabbis who expressed their opposition to doctors was R. Eliahu, the Gaon of Vilna (1720-1797). It is told that he once went to visit his brother, R. Yissakhar Dov, who was sick. Two doctors were present. The Gaon turned to his brother and asked, "Why do you need doctors? Surely God heals the sick?" One of the doctors interjected, "Did God create doctors and medicines for nothing?" "And why did God create pigs?" retorted the Gaon. "Not for consumption by Jews! So too with doctors: maybe the gentiles go to them, but for the Jews, God is the Healer of the sick and Creator of remedies" (HaTzaddik R. Zundel MiSalant, Jerusalem 1927, p.115).
Rabbi Pinchas Shapiro of Koretz (1726-91), Rabbi Barukh of Medzeboz (1757-1810) and Rabbi Yaakov Yitzchak Horovitz, the Chozeh (Seer) of
We have already noted that the accepted halakhic opinion today is that of the TaZ, that "it is a positive obligation to turn to the doctor in times of illness". Nevertheless, only a couple of generations ago a leading halakhic authority, Rabbi Avraham Burnstein of Sokhatchov (1839-1910), wrote of the Ramban's viewpoint: "The correct interpretation of the words of the Ramban would seem to be that any person who does not resort to medical treatment but trusts in God is called a tzaddik in this matter, and every person is entitled and indeed commanded to do this. Since we clearly see that doctors are prone to cause harm, one may put one's trust in God in order not to expose oneself to mortal danger in practice" (Avney Nezer on Choshen Mishpat #193).
The main source for Rebbe Nachman's attacks on doctors is in Rabbi Nachman's Wisdom #50, where Reb Noson reports the main thrust of a number of separate discussions by Rebbe Nachman, mostly after his return to Breslov from Lemberg in the summer of 1808 - this was the period in which Rebbe Nachman gave most of his major discourses on healing.
"The Rebbe often spoke to us about physicians and medicine, denouncing them in the strongest terms. He advised anyone who cares about his life and that of his family to avoid them, even in the case of serious illness. One should `cast his burden on God' (Psalms 55:23) and depend on Him alone (cf. Isaiah 50:10). One should not resort to medicines and doctors even in a place where there are outstanding physicians, for they are closer to death than to life (Shabbat 129b).
"Even an outstanding doctor is unable to diagnose the illness exactly or to determine the appropriate medicine, because so many variables are involved - the constitution of the individual, the nature of the illness, the time and season, etc. It is extremely difficult for the doctor to take account of all these variables without making mistakes, as they themselves acknowledge. They can easily do irreparable damage, jeopardizing the patient's life. This applies even to the greatest doctors, and certainly to the majority of doctors found in our locality, most of whom don't understand the difference between right and left and are literally murderers, killing people with their own hands. One should flee from them as from a bowshot, not risking one's life or that of the patient one puts in their hands. It is very dangerous to depend even on the greatest physicians. One who falls into their hands separates himself from the living. The Rebbe spoke at great length, but it is impossible to record everything he said regarding this.
"He told us that when he was in Lemberg, a place in which outstanding physicians were gathered, one leading doctor testified that it is best to keep as far away as possible from medicines and doctors. He said that there has already been so much research into medicine that the experts now know absolutely nothing, because after so much research they see that it is impossible to establish the truth. There are also many deep divisions among them as to how to treat various illnesses. In Lemberg there was a controversy between two groups of doctors who argued about the correct approach to a certain dangerous illness. One group recommended a bland diet, holding that strong, spicy foods were highly dangerous. The other group advised exactly the opposite, saying that only strong and spicy foods should be taken for this illness, as sweet or bland foods were very harmful. Each of the two groups put forward strong arguments in favor of their position, and each group regarded any diet other than the one they recommended as being fatally poisonous. Each of the two groups included some of the most outstanding specialists in the field, yet they were unable to determine the truth. Even with practical experience it is impossible to ascertain where the truth lies, because sometimes experience seems to confirm one view, at other times the opposite.
"Thus we see that it is impossible to depend on doctors since they themselves are extremely confused and they are unable to ascertain the truth. How can someone put his life in their hands and let it hang there by a single thread - because it takes only the slightest error by the doctor and he can destroy a person's life and actually kill him, as we see so often, for many people die because of doctors. The art of medicine involves many very fine intricacies, but they are hidden from the doctors `like bones in a full stomach' (Ecclesiastes 11:5), to the point that the doctor is unable to take account of all the subtle details without error.
"One must therefore avoid them and flee from them. When someone is sick or has a sick person at home he should not say: `If so, who should I rely on? One must do something to try to cure the patient by natural means! How can I leave him without making any effort to save him?' This is really foolish. Since the doctor is closer to death than to life, in the end there is no option but to depend on God alone. Surely it is better to depend on God from the outset and not put the sick person in even greater danger by handing him over to the doctor! The majority of doctors are agents of the Angel of Death! One should imagine oneself to be in the wilderness or in a forest. There one has to rely on God alone because there is nothing else to do. Likewise now, even though one may live in a place where doctors and medicines are available, even so, seeing that they themselves are so confused, and considering the many other dangers involved in medicines, it is probable that, far from helping, they will actually cause harm. If so, why use natural methods when the likelihood of benefit is remote and the dangers are so great?
"The Rebbe spoke at length with outstanding doctors, and he understood this matter very clearly. He gave us the strongest warnings to keep well away from them. It is impossible to record everything he discussed in this regard. He told us of a king who killed all the doctors in his kingdom because they did so much harm. He once said in jest that the Angel of Death has to oversee the entire world and it is very difficult for him to do all the killing himself. He therefore appoints agents in each locality, and these are the doctors, who are his agents to kill people, for they kill enormous numbers of people. Happy is the man who avoids them and trusts in God alone.... The Rebbe repeatedly told us to avoid them. Regardless of what happens, one must lift one's eyes to heaven and rely on God alone.
"As for the fact that the Rebbe himself traveled to Lemberg and submitted to medical treatment, this involves very deep mysteries. His reasons for travelling there had nothing to do with medical treatment, but with other matters known to him alone. His intentions were as hidden and mysterious as they were on his journeys to Kaminetz, Novorich and Sharograd. All the Rebbe's travels involved awesome mysteries hidden from all human eyes.... The same is true of his trip to Lemberg. After his arrival there he was compelled from on high to submit to medical treatment for reasons known only to him. But when he returned from there he spoke more strongly than ever about the need to avoid medicines and he gave many lessons on the subject. Even before his journey to Lemberg he used to talk about this, but afterwards he stressed more than ever the need to keep away from doctors" (Rabbi Nachman's Wisdom #50).
Medicine in the time of Rebbe Nachman Sanitation was extremely primitive and water supplies were often contaminated. Piles of garbage bred all kinds of diseases and attracted vermin who spread them. There were freqent outbreaks of plague. Smallpox, measles, scarlet fever, chicken pox, cholera and diphtheria took an especially heavy toll on the young. Childbed (puerperal) fever was fatal, with the result that there was a terribly high incidence of death in childbirth. Congenital and acquired blindness were common, as was deafness caused by ear infections. The limited diet of the poor led to malnutrition and its associated diseases. It was to be the better part of a century before Louis Pasteur (1822-95) would establish the germ theory of disease, laying the basis for modern bacteriology and immunology. The principles of antisepsis pioneered by Joseph Lister (1827-1912) were as yet unknown. Only the most primitive painkillers were available - not until the 1840's was anesthesia first used, opening the way for surgeons to operate on the hitherto inaccessible interior of the body. Yet although the medicine of the late 18th and early 19th centuries may today appear primitive, many physicians of the time saw themselves as advanced pioneers, having rejected medieval dogma based on the works of Galen and Avicenna in favor of the rationalist-mechanistic approach of Descartes and his followers. The development of increasingly powerful microscopes gave a boost to the study of anatomy and pathology, and the work of the Paduan professor Giovanni Battista Morgagni (1682-1771) established concepts and study methods that remain the basis of contemporary medical investigation and teaching. However, actual medical practice tended to lag behind what are now seen as significant discoveries. Bloodletting, purging and vomiting, dietary restriction and nonspecific drugs continued to be the mainstay of therapeutics, though there was considerable interest in faddish treatments such as the use of stimulants and sedatives, while new drugs like quinine and digitalis were taken up with great enthusiasm. Only the wealthy could be assured of the services of a trained doctor, especially in Russia, which had only one medical school compared with the dozens in Britain, France, Germany and Italy. Dispensaries were scarce. Such hospitals as existed had no organized clinics. For the wider public, the void tended to be filled by enterprising apothecaries, mountebanks and peddlars of nostrums. Barber-surgeons carried out bloodletting and tooth extractions and also dealt with fractures, dislocations and external ulcers. Untutored itinerant wound-doctors would operate for cataracts, bladder stones and hernias. The poor relied on old wives' remedies and sometimes actual sorcery (see Tzaddik #140). |
Danger!
We might have expected that, as a religious teacher, Rebbe Nachman would have founded his opposition to doctors and medicine primarily on the need to have faith and trust in God rather than relying on human intervention to cure illness. Rebbe Nachman certainly did urge his followers to lift their eyes to heaven and cast their burden on God. He taught a spiritual pathway of healing through faith, prayer and joy, and he emphasized that the first step in all healing is redemption of the soul. Yet it is noteworthy that in the above passage, Rebbe Nachman does not reject doctors and medicine only because dependence on them shows a lack of trust in God. His opposition is based primarily on the fact that he sees medicine as a danger to the life of the sick person.
| Reb Noson said: "God is so great that He can send a cure even after someone goes to a doctor!" (Siach Sarfey Kodesh I-63, etc.) |
It cannot be said that Rebbe Nachman considered medicine to be totally ineffectual. In a number of passages in his writings he mentions the power of medicinal herbs to influence the four bodily elements of fire, air, water and earth (e.g. Likutey Moharan I, 57 end and II, 5:1). the Kabbalah view is that illness results from imbalance among these four elements. The problem is that the human body is so complex that in practice no doctor could ever determine the precise nature of the imbalance involved in the illness of a given individual, nor could he know the exact combination of medicines needed to correct it.
In the words of Rebbe Nachman: "It would take a great medical expert to know how to balance the elements contained in each of the different herbs in order to produce the precise remedy needed by a particular patient given the particular element that is weak and damaged in his case" (Likutey Moharan II, 5:1). Illness and healing involve so many variables that medicine will always be based on unproven hypotheses and guesswork. Rebbe Nachman sees evidence of this in the disputes between different groups of doctors over how to treat various illnesses. With so much potential for error, the doctor can easily prescribe inappropriate treatment, which may cause irreparable damage or death.
One of the most usual responses to Rebbe Nachman's warnings against doctors is that it could be dangerous for the patient not to submit to treatment. This is what makes Rebbe Nachman's opposition to medicine seem to contradict the Torah principle that everything must be done to protect human life. The assumption is that illness poses a definite threat to the patient, while medical treatment is most likely to be safe and successful. However, Rebbe Nachman's contention is that the real danger lies in resorting to medicine. This is because it is quite impossible for even the best doctor to attain a clear understanding of the nature of a particular problem. Consequently, any treatments used are a matter of guesswork, and are more likely than not to be hazardous. Sickness itself is dangerous enough, but for Rebbe Nachman, medicine is even more dangerous:
"If a person has someone sick in his house andsomebody came and told him to give the patient a blow with a big wooden club, he would certainly be very shocked. Yet when one puts the patient in the hands of the doctor, it is literally like handing him over to a murderer. The doctor's remedies are more harmful than the blow of a murderer. Who would want to kill the patient with his own hands? Just because you have to do something to try to save the patient, does this mean that you should hand him over to a doctor? You might as well call someone to beat the patient to death" (Tzaddik #194).
Tried and tested remedies
Rebbe Nachman's view of doctors and their lack of understanding was shared by other contemporaries of his. Using language no less strong than Rebbe Nachman, the Pele Yo'etz (Rabbi Eliezer Papo, 1785-1828) writes: "Today there are multitudes of ignoramuses who take up medicine as a way to make a living without having any insight into the art of healing. Whoever chooses can practice medicine and get a name for himself as an expert doctor while actually he is like a blind man feeling his way through the darkness without understanding the difference between right and left. Such doctors are wholesale murderers!" (Pele Yo'etz, Rofe #1).
It is undeniable that medical knowledge and expertise have expanded explosively since the end of the 18th century, and they continue to grow. Given that Rebbe Nachman's critique of doctors is largely founded on their lack of understanding of the workings of the body, it is fair to ask whether his polemic was directed primarily against the primitive medicine of his time or whether it would still apply today.
Nowhere in Rebbe Nachman's writings is there an explicit statement indicating that his warnings against doctors were restricted to his own time and place and would not apply if medical knowledge were to advance significantly. In fact, we see that Rebbe Nachman took a skeptical view of the growth of medical knowledge: "He said that there has already been so much research into medicine that the experts now know absolutely nothing, because after so much research they see that it is impossible to establish the truth" (Rabbi Nachman's Wisdom #50). It is significant that although Rebbe Nachman had always advised his followers to avoid doctors, his warnings became stronger than ever after his trip to Lemberg, whose Austrian-trained doctors were then among the most advanced in
On the other hand, there is one statement by Rebbe Nachman that places all his warnings against doctors into a very different light - a statement that provides a basis for those who wish to argue that his warnings simply do not apply to contemporary medicine. This is his statement urging his followers to have their children vaccinated against smallpox. This disfiguring and often fatal disease was then prevalent throughout
It was not until the 1790's that the English country physician Edward Jenner observed that those who had been infected with cowpox did not become infected with smallpox. In 1796 he performed the first vaccination on a young boy, and found that, despite the boy's subsequent exposure to smallpox, he did not become infected. Knowledge of the new technique spread rapidly throughout
In the midst of this controversy, Rebbe Nachman came out in favor of vaccination in the strongest terms:
"Every parent should have his children vaccinated within the first three months of life. Failure to do so is tantamount to murder. Even if they live far from the city and have to travel during the great winter cold,they should have the child vaccinated before three months" (Avaneha Barzel p.31 #34).
Rebbe Nachman's championship of vaccination is clear proof that his opposition to doctors and medicine was in no way bound up with some kind of retrogressive attitude of suspicion towards modernity and innovation per se. Here was a newly-discovered technique with a proven power to prevent a dangerous disease, and within a matter of a few years Rebbe Nachman came out emphatically in favor - Jenner first discovered vaccination in 1796, and Rebbe Nachman's (undated) statement must have been made some time before his death in 1810.
Strictly speaking, vaccination is not so much a remedy as a preventive measure. Rebbe Nachman's powerful endorsement seems to imply that he would have been no less in favor of tried and tested measures for preventing other diseases - unlike the Ramban, who says that "when the Jewish People are in a state of spiritual perfection... they have no need of medical procedures even as precautionary measures". As we will see later, Rebbe Nachman himself saw his healing pathway of faith and prayer as the most powerful form of preventive medicine. Nevertheless, from his endorsement of vaccination, we can infer that Rebbe Nachman would not have been opposed to actual preventive medical techniques where they had proven their effectiveness.
An open question
A far more open question is whether the tremendous advances in medical techniques since Rebbe Nachman's time would have led him to modify his rejection of medicine when it comes to remedies for actual illness as opposed to prevention. The contemporary medical armory includes a host of well-established methods of diagnosing and treating all kinds of problems, many of them with extremely high success rates. If Rebbe Nachman accepted vaccination as a "tried and tested technique," would he also have been in favor of proven modern methods of treatment?
We saw earlier that R. Avraham Ibn Ezra, while rejecting resort to doctors for internal medical problems, acknowledged that the doctor has license to heal wounds and injuries that are visible on the exterior. R. Yonatan Eybeshetz (1696-1764) explains that in the case of an external problem, "the doctor can easily ascertain the full extent of the problem with almost mathematical precision, which is not the case when the problem lies in the interior of the body, where the doctor's eye cannot penetrate. Here he is forced to rely on inference and probability. Doctors cause much damage and are responsible for many deaths, for in such cases it takes great caution and clearheaded deliberation to avoid error" (Kraiti uFlaiti #188). But some halakhic authorities argue that modern scientific advances have broken down the distinction between external and internal physical problems, since blood tests, biopsies, body scans and the like provide information about the interior of the body that is at least as accurate if not more so than information gained through visual examination of the exterior of the body (see Emek Halakhah #18).
There is some indication that a viewpoint similar to that of Ibn Ezra - that turning to doctors for treatment of "external" disorders is permissible - was accepted by some of Rebbe Nachman's later followers. Thus while R. Avraham Chazan (1849-1917), outstanding leader of the fourth generation of Breslover Chassidim, did not go to doctors, he is known to have gone to have his teeth examined on the grounds that dentistry does not come within Rebbe Nachman's prohibition against doctors (Siach Sarfey Kodesh III-446). Does this mean that Rebbe Nachman's warnings against doctors and medicine no longer apply today, when there appear to be so many "tried and tested remedies," and scientific advances have made it possible for doctors to gain information about the interior of the body in ways undreamed of in the times of Ibn Ezra, Rebbe Nachman or even R. Avraham Chazan?
The fact that Rebbe Nachman's critique of the doctors is based on their ignorance of the workings of the body, while he himself endorsed one proven medical technique, leaves plenty of leeway to interpret his rejection of doctors and medicine in different ways. Purists are at liberty to argue that Rebbe Nachman never explicitly favored resort to medicine to cure actual illness, and there is nothing in his writings to suggest that his warnings against doctors were restricted to his own time and place. On the other hand, many contemporary adherents of the Breslov chassidic movement use the concept of "tried and tested remedies" to justify resort to doctors and medicine on the grounds that enormous numbers of standard contemporary medical techniques have been proven effective.
Medicine today
No one can deny that contemporary medicine provides successful aids and remedies for all kinds of conditions that used to cause great misery. The effectiveness of many present-day techniques is practically beyond dispute. At the same time, there are still many other techniques that involve a greater or lesser degree of risk - angioplasty and coronary bypass surgery for heart disease, radiation and chemotherapy for cancer, and many more. Whether a given technique is "tried and tested," "reasonably safe," "experimental," "shaky," "risky" or "outright dangerous" often depends on which doctor you speak to or which reports you read.
The weaponry in use against many all-too-common illnesses often seems blunt and crude, and involves all sorts of hazardous side-effects. In chemotherapy, for example, doctors frequently experiment with formula after formula in the hope of finding one that will be effective in a particular case. The medications involved are often so nonspecific that even if they kill the cancer cells they are aimed against, they can also cause appalling damage to healthy cells. All kinds of other drugs - antibiotics, anti-inflammatory agents, antidepressants, sedatives and many others - are prescribed quite routinely today despite the fact that no one really knows what long-term effects they may have on the immune system, the nervous system and bodily functioning in general.
Even those who regard contemporary orthodox medicine as the pinnacle of scientific achievement must concede that the mere fact that a medical student is granted a license to practice does not turn him into an expert healer. We must distinguish between the accumulated body of medical knowledge on the one hand and the living human beings who actually examine, diagnose and treat patients on the other. Much of the prestige of the medical profession stems from the fact that medicine is supposedly based on scientific method. But medical practitioners are rarely able to keep abreast of the latest in scientific research, or even to employ strict scientific method when it comes to actual diagnosis and treatment. Laboratory tests may sometimes (though not always) provide definite results. But interpreting them and diagnosing exactly what is wrong with a particular patient is almost always a matter of subjective judgment, as are decisions about the best course of treatment.
With all the advances in medical science, numerous aspects of the workings of the body remain obscure. This is especially evident in the case of various "mystery conditions" that simply defy all diagnostic tests, like certain cases of chronic fatigue, strange aches and pains, certain kinds of digestive problems, and so on. Conventional medicine is at its best when dealing with readily identifiable problems that seem to call for clear, straightforward solutions. But as we have already noted, it has less to offer the chronically ill and those suffering from what are often dismissed as "neurotic complaints," even though these groups constitute a high proportion of all patients. Even diagnoses that seem fairly obvious often turn out to have been partial at best, while treatment for one problem may cause a host of new ones.
Conventional western medicine tends to present itself as an impressive edifice of scientifically based knowledge that is steadily growing. Yet there are still numerous areas of dispute within the ranks of orthodox medicine, just as there were among the doctors in Rebbe Nachman's time. Theories, techniques and treatments that were sacrosanct in one generation are discredited and rejected in the next. There are also far-reaching controversies between conventional practitioners and devotees of various types of so-called "alternative" medicine, who often take a radically different view of physical functioning and therapy.
Rebbe Nachman's critique of doctors would seem to be directed not only against orthodox physicians but against all "healers" who seek to treat bodily conditions with drugs, manipulations and other physical treatments without taking account of the mental, emotional and spiritual dimensions of illness. As regards "spiritual healers," this is a dangerous, catch-all phrase which is applied today to a wide variety of operators. A few may be sincere and well-intentioned, but many others "have no understanding of the difference between right and left," while some employ methods forbidden by Torah law.
A matter of faith
It would be easy to assemble a lengthy catalog of criticisms of doctors and medicine. We've all heard horrendous tales of slapdash examinations, faulty and mistaken diagnoses, wrong and damaging treatments, malpractice, medical arrogance, gross insensitivity to the needs and feelings of patients and their dear ones, etc., etc. Indeed, in a conversation between Reb Avraham Chazan and his father, Reb Nachman Chazan of Tulchin (1813-84), who was Reb Noson's closest disciple, Reb Avraham said that he found Rebbe Nachman's warnings against doctors perfectly understandable after seeing how they practiced medicine. But Reb Nachman replied: "You shouldn't follow the Rebbe's teachings because you find them understandable and acceptable. That's the way you find them today, but tomorrow you might not find them acceptable! When you have faith in the Rebbe's words without giving explanations and reasons of your own, you will always stay firm in following his guidance" (Siach Sarfey Kodesh III:299).
The teachings of the Tzaddik ultimately have to be accepted on faith, because they are based upon axioms that are themselves founded on faith. Rebbe Nachman's critique of the doctors is ultimately rooted in the belief that physical illness is more than a matter of mere physical malfunctioning. Physical illness is an expression of a deep-seated spiritual flaw, and by seeking to treat illness on the physical plane alone, the medical doctor misses the point, and may indeed cause harm. In the words of Rebbe Nachman: "Even after the treatment, the illness remains. It's like sewing a patch onto a garment. The illness remains an illness. It's just that the doctor sews a patch over it" (Siach Sarfey Kodesh I:9).