Chapter 17

Nature and Beyond

The first item in the chapter on Healing in Rebbe Nachman's Aleph-Bet Book sums up his healing pathway:

"Know that each herb has a unique power to heal a particular illness. However, all this is only for the person who has failed to guard his faith and morality and has not taken care to avoid transgressing the prohibition against despising others (Avot 4:3). But when a person has perfect faith, guards himself morally, and lives by the principle of not looking down on anyone at all, his healing does not depend on the specific herbs that have the power to cure his illness. He can be healed through any food and any drink, as it is written, `And He will bless your bread and your water, and remove sickness from you' (Exodus 23:25). Such a person does not have to wait until the specific remedy for his illness is available" (Aleph-Bet Book, Healing #1).

The ideas expressed concisely in this teaching are explored at length in Rebbe Nachman's discourse, "Sound the Shofar - Dominion over the Angels" (Likutey Moharan II, 1), a full translation of which will be presented in the following chapter together with commentary. As we will see there, prayer is the means by which healing power is channeled into food and drink, and Rebbe Nachman discusses the three main conditions that must be satisfied in order for a person to attain true prayer.

In the above-quoted teaching from the Aleph-Bet Book, Rebbe Nachman summarizes these three conditions. They are: to have perfect faith in God, to guard oneself morally - which means cleansing oneself of all desire for forbidden sexual activity - and to have respect for other people. Those who lead their lives in this way can be healed without medicines: healing power can be channeled to them even through their regular food and drink. The body is a physical entity and may need to receive healing through some physical substance. But for those who lead a Godly life, this physical substance need not be actual medicine but can be even ordinary food and drink.

A two-tiered view of healing

Implicit in this teaching is a two-tiered view of healing. By saying that "each herb has a unique power to heal a particular illness," Rebbe Nachman shows that he did accept, at least in principle, that illness may be able to be cured through the use of medicines in accordance with the laws of nature. He certainly recognized that physical factors can be the cause of illness - for example, he discusses how excessive eating can bring on fever (Likutey Moharan I, 263). And by the same token, he acknowledged that physical factors can bring about a cure. When he said that illness is caused by disharmony among the four bodily elements of fire, air, water and earth, he clearly saw this as a physical phenomenon, even though the roots of the imbalance may lie on the spiritual level. Now each of the various medicinal herbs has a unique power to influence one or more of the elements in a particular way, and thus a skilfully blended compound of herbs may be able to restore balance and thereby effect a cure.

However, "all this is only for the person who has failed to guard his faith...." This implies that healing through medicine is for people who are on a lower spiritual level. But for those on a higher level, there is a pathway of healing that is beyond nature. Healing can be channeled through faith and prayer without the need for specific herbs and medicines. We would call such healing "miraculous" or "providential."

In Rebbe Nachman's view, the spiritual pathway of healing is superior for a number of reasons. For one thing, as we have seen, he regarded medicine as hazardous, since "even an outstanding doctor is unable to diagnose the illness exactly or determine the appropriate medicine, because so many variables are involved.... It is extremely difficult for the doctor to take account of all these variables without making mistakes" (Rabbi Nachman's Wisdom #50). But an error could easily prove harmful or even fatal. Moreover, even though illness manifests itself on the physical level, Rebbe Nachman held that at its root it is caused by a flaw on the spiritual level. Without correcting this, medical solutions alone can never be effective over the long term. As Rebbe Nachman put it, they are "like sewing on a patch" (Siach Sarfey Kodesh I:9).

Yet there is also another, deeper reason why Rebbe Nachman placed healing through faith and prayer on a higher level than medicine. It is not man's body that is the essential person, the man himself, but his soul. The physical body is given to man as an adjunct to his soul, an instrument to serve him during his time in this world. With its animal needs and desires, the body provides man with his challenge in this world, and it is also the instrument with which he carries out the mitzvot, through which he comes to his ultimate destiny of connection with God.

In this world the soul certainly needs the physical body, but as a spiritual entity, the soul is on a far higher level. The physical body is within nature and bound by its laws. But the soul has access to higher, spiritual realms that are beyond nature and are governed by a different law. The soul has the ability to channel power from these higher realms to affect even the natural realm. Thus, when the body is sick, the soul has the power to channel healing to it by purely spiritual means, especially through prayer. And when man draws what he needs through prayer, he attains the highest level of human dignity. In the words of Rebbe Nachman:

"Through prayer we have the power to channel God's providence in a way that goes beyond nature. Nature may dictate one thing, but prayer has the power to change nature. This is `greatness' - `For what great nation is there that has God so near to them as HaShem our God whenever we call on Him?' (Deuteronomy 4:7). This is our greatness - that God hears our prayers and alters the course of nature through His providence" (Likutey Moharan I, 250,).

Knowledge and awareness of God: Da'at

Rebbe Nachman taught that we must pray for everything we need:

"God may give you food and clothing and everything else you need even though you do not ask for them. But then you are like an animal. God gives every living thing its bread without being asked. He can also give it to you this way. But if you do not draw your life through prayer, then your life is like an animal's. A man must draw all the necessities of life from God through prayer alone" (Rabbi Nachman's Wisdom #233).

It is certainly possible for us to try to satisfy our material needs and desires through exclusive use of this-worldly means and strategies. However, if we do so, we are living only on the physical, "animal" plane, and we remain unaware that all our needs are ultimately provided by God. But our whole purpose in this world is to come to know and be connected with God. This is why we must turn to God for what we need - through prayer.

God created the natural order with its laws and regularities in order to provide man with the necessary environment of trial and challenge to bring him to his destiny. The natural order may seem like an independent realm that is separate from God and governed by its own rules. But in reality, הטבע  (hateva), "nature," is the same as אלקים  (Elokim), God. (The numerical value of the Hebrew letters of each of these two words is the same, 86.) Nature is a veil from behind which and through which God governs the world.

From our side of the veil, it may often seem as if God is "not there," as it were - as if it is up to us to seek to influence the material order through our own physical efforts in order to secure our needs. It is precisely this illusion that provides us with our challenge in this world. Our task is to search for God behind the veil. We must have faith in that which is beyond our grasp. God wants us to attain da'at, understanding, to "know that HaShem is Elokim" (Deuteronomy 4:39). We have to believe and know that even the apparently impersonal, independent, pluralistic natural order, HaTeva (=Elokim), is also under the complete control of HaShem, the unitary God.

In Himself, God is beyond nature, and has the power to control and change it in ways that are not necessarily comprehensible in terms of "scientific" law. The way we come to know this is through prayer, which enables us to connect with God and to channel His higher power into this world and even to change nature. The greater our knowledge and awareness of God, the more powerful our prayers become.

To say that God governs the world in ways that are not always comprehensible in terms of scientifically observable regularities does not mean that His providence is somehow irrational and capricious. It means only that the rationale of God's providence is on a higher level than the human mind is capable of grasping. For this reason a "supernatural" event that seems to defy the laws of nature is called a נס  (ness), a "miracle." The word ness signifies something elevated. Literally, it means a "flag." Just as a national flag flying over a certain territory signifies who has control over it, so an event that seemingly defies nature, a ness, is a "banner" pointing to the fact that "God is the King over all the earth": God is in control.

With our this-worldly, material intelligence it is not possible to make sense of the higher law through which God governs the universe. But the Torah was given to us to reveal the secrets of the divine system of providence and its rules. The deeper our understanding of the Torah, the more we can begin to grasp some of the ways in which God conducts the world. Moreover, the Torah gives us a pivotal role in this providence through our fulfilment of the mitzvot in general and especially through our prayers. These give us the power to influence the system of angels and other celestial forces through which God conducts the universe. The deeper our attachment to the Torah and the mitzvot, the greater our power.

The Torah is the Covenant between God and the Jewish People. It is a "contract," under which the Jewish People is privy to a special providence that is beyond nature, above the angels, stars and other forces through which God governs the rest of creation. The sign of this Covenant is the circumcision. The stripping off of the foreskin alludes to the way in which the Torah and mitzvot enable us to strip off the veil of the natural order so as to reveal the Godly providence that lies beyond it.

Moses told the Jewish People, "You are children to HaShem your God" (Deuteronomy 14:1). A king governs his kingdom through the agency of an hierarchical apparatus of ministers and officials. But the king's own children enjoy special favor. They have easy access to their father in person, and receive everything they need directly from him. So it is with us - as long as we observe our side of the Covenant and adhere to the Torah with all our hearts.

God's kindness

Most people find it impossible to sustain such an exalted level of spirituality for very long. Rebbe Nachman tells us that it is to their advantage that God also governs the world through nature:

"God shows us great kindness in governing the world both with personal providence and through the laws of nature. When people do good, God deals with them providentially in a way that goes beyond nature. However, when someone is not good, if God were to oversee his life providentially, no good could ever reach him [as he is not deserving. However, out of kindness,] God abandons this person to the laws of nature, and this means that things may then go well for him through the law of averages. If God's only way of running the world were through providence - rewarding good deeds and punishing sin - this could lead to a total breakdown of providence, since if God were to see someone acting improperly and dealt with him in anger, He might cast him out completely. Instead, God abandons him to nature, and when he improves his ways, He deals with him providentially.

"But actually, we are really unable to understand what is `nature' and what is `providence.' The truth is that even the laws of nature are really God's providence. However, the human mind is unable to grasp the paradox that what appears to be the law of nature is really God's providence" (Likutey Moharan II, 17).

The two tiers of God's way of running the world - providentially and through nature - correspond to the two tiers of healing: through faith and prayer on the one hand, and by medicine on the other. Those who fulfil the Covenant are privy to God's special providence and can be healed through faith and prayer alone without medicine. This is the point of the Ramban: "When the Jewish People are in a state of spiritual perfection, their physical bodies are not governed by nature at all. This applies to the nation as a whole and to each individual Jew. For God `will bless their bread and their water, and remove illness from their midst' (Exodus 23:25). They will have no need for doctors, nor will they have to follow medical procedures even as precautionary measures, `for I, God, am your healer' (Exodus 15:26)" (Ramban on Leviticus 26:11).

On the other hand, those who are not on such a level of spiritual development are likely to view bodily illness as essentially a physical phenomenon, and they will seek to be cured through medicine. This view of illness is rooted in a lack of da'at - an absence of true awareness that physical symptoms express a spiritual flaw, and that genuine healing can come about only through correcting the flaw by turning to God in prayer and repentance. Since they lead their lives as if the things that happen to them fall under the laws of nature, measure for measure God "abandons them to the laws of nature" - to the vicissitudes of illness and of the medical services.

Yet even this is in fact a mark of God's kindness, because then "things may go well for them through the law of averages," and they may indeed be cured "by a particular drug and a particular doctor." If so, they may well bless the wonders of medicine. But these too are really God's miracles, because "the truth is that even the laws of nature are really God's providence." Their illness and medical treatment may well cause them deep distress and suffering. Yet this too is sent from God for their ultimate good, because it comes to cleanse them of their sins. Their distress and suffering are aspects of the "decree" of sickness, which will necessarily run its course unless sweetened by a "redemption" carried out by a Tzaddik.

Know your level

Without a doubt Rebbe Nachman would have wanted every Jew to attain such a level of closeness to God that he could be healed of any illness through faith and prayer alone. But the Rebbe surely understood that - at least until the time of Mashiach - the overwhelming majority will continue using medicine. This is probably one of his reasons for saying, "You know I don't hold by doctors, but if you're going to go, make sure you choose the very best!" (Siach Sarfey Kodesh I:8)

Many people will be happy to see Rebbe Nachman's warnings against doctors as having been primarily directed against the primitive medicine of his time, and they will have no scruples about taking advantage of the many benefits contemporary medicine seems to offer. Even those who have the deepest reverence for Rebbe Nachman, and who accept that illness has a spiritual dimension, may still feel that to depend on faith and prayer alone for healing would be beyond their capabilities. But for those who look to Rebbe Nachman as their main source of spiritual guidance and seek to follow his teachings to the very end, the question may not be whether his warnings against doctors apply to the world in general, but rather: "Do they apply to me? If I turn to doctors and medicine in times of illness, does that show a lack of faith?"

No one has the right to seek to prevent anyone else - even their own spouse or children - from receiving medical attention unless there are clear grounds for believing that a given treatment could be harmful or dangerous, in which case other medical opinions should be sought and a rabbi consulted. However, there are times when a person who is sincerely trying to follow Rebbe Nachman's spiritual pathway is faced with his own illness, and questions whether he should submit to medical treatment or try to rely on faith and prayer alone for healing.

The answer depends upon that person's spiritual level (Rabbi Yaakov Meir Shechter). What this means is brought out in a discussion by Rabbi Eliahu Eliezer Dessler (1891-1954) about the apparent contradiction between the view of the Ramban that "those who seek out God will not turn to the doctors" (Ramban on Leviticus 26:11) and the opinion of the Rambam that failure to go to a doctor in times of need is irresponsible. For in the Rambam's opinion, "just as a hungry person can and must eat and shows no lack of faith by doing so, similarly a sick person can and must turn to doctors and medicines, and should thank God for including medical remedies in His creation" (Rambam, Commentary on Mishneh, Pesachim 4:9; see p. 38).

In the words of Rabbi Dessler:

"A deeper examination will reveal that the approaches of the Ramban and the Rambam are not contradictory at all, but that each applies to people on different levels. The highest level is when a person recognizes the hand of God in all the different things that happen to him and understands that God governs his life directly. Such a person turns to God alone for whatever he needs, for He is the source of all things. If a person on this level becomes ill, he will go to the prophet for insight into the spiritual cause of his illness and to find out what God wants of him in order to correct his mistakes. For such a person to turn to a doctor for a medical remedy would amount to a defection from God, as if it is possible to flout God's will and be cured without rectifying the spiritual flaw that is the root cause of the sickness. Such a person is certainly a sinner, and this is the prophet's complaint against King Asa, who `even in his sickness did not seek out God, but turned to the doctors' (Chronicles II, 16:13). In such a case, the Rambam would agree.

"On a lower level is the person who takes account of natural causes, and therefore God too hides His providence from this person and governs his life through natural causes. In the words of the Ramban, `God abandons him to the vicissitudes of nature.' Such a person certainly has an obligation to pray to God to heal him, but he must use medicine and thank God for creating the remedy for his illness (cf. Shulchan Arukh, Orach Chaim 230:4), and thereby recognize God's providence and His kindness to him, and learn to improve his ways. The Ramban would also accept this.

"If a person on this level refuses to take medicine because of scruples about resorting to physical means of being cured, the Rambam considers this to be foolish and irresponsible, because each person must serve God according to his level. A person who seeks to act in accordance with a level that is in fact beyond his true capacity because he is still on a lower level is simply deceiving himself, and this is what the Rambam considers foolish and irresponsible" (R. Eliahu Eliezer Dessler, Mikhtav MeEliahu III, p.170-3).

To have the honesty and humility to acknowledge one's true level shows far greater spiritual maturity than to make a pretense of being on a higher level than one really is. In the words of Rebbe Nachman: "A person should look upon himself as if he were less than he really is: that is true humility. And at the very least, he should not look upon himself as if he is more than he really is" (Likutey Moharan I, 79). Such arrogance is all too often the prelude to a great fall (ibid. I, 168).

A person who is considering depending on faith and prayer alone for healing must ask himself searching questions about his true spiritual level and his real motives. How much faith does he really have? Does he turn to God alone for his livelihood and everything else he needs in life? Or does he use worldly means of attaining them? Is his sole motive for relying on God alone for healing to sanctify and glorify the Name of God? Or is this a rationalization that comes to cover over other motives, such as fears of what a doctor might tell him about his condition, apprehension about possible pain or the disruptive effects treatment may have on his life, or feelings of resentment at having to submit himself to the doctor's authority?

These and similar motives have nothing to do with pure faith in God, and have no validity at all as reasons for avoiding necessary medical treatment. As Rebbe Nachman said, "Sometimes when people don't want to suffer a little, they end up suffering a lot!" (Siach Sarfey Kodesh 1-6) It is far preferable to have a medical problem treated promptly in its early stages than to allow it to develop into what may turn out to be catastrophic proportions.

"What people do at the end I want you to do at the beginning!"

Rebbe Nachman said, "What people do at the end I want you to do at the beginning!" People resort to passionate prayers when they see that all other ways of saving the situation have failed. But Rebbe Nachman wanted us to implore God for help at the very beginning of the trouble (Siach Sarfey Kodesh I:293).

One can submit to medical treatment when necessary and still take a spiritual view of health and sickness at the same time, striving to follow all of Rebbe Nachman's teachings on health and healing through faith, prayer and joy. If there is any lack of faith involved in turning to doctors and medicine, it is when one pins all one's hopes of a cure on the means rather than on God. In the words of Rebbe Nachman, "Even while busying ourselves with these means, it is necessary to believe in God alone and not to make the mere means into the essence" (ibid. 62:6).

The late Lubavitcher Rebbe, Rabbi Menachem Mendel Shneerson (1902-94), wrote to a person undergoing medical treatment:

"When a Jew, man or woman, is unwell and is obliged to consult a doctor, the idea is not that the doctor has the power to do whatever he wants, but that the Holy One, blessed be He, has chosen the doctor to be His agent to execute the mission He has sent him on. And when one trusts in God and has complete faith that He governs the entire world, one can merit to see with one's own physical eyes how at every single step the Holy One takes each of us by the hand and leads us to good, physically and spiritually" (Refuah Shelemah p.33).

In another letter, the Lubavitcher Rebbe wrote:

"We know that our Torah, the Torah of life, teaches us in the verse `and he will surely heal' (Exodus 21:19) that the doctor has been given sanction to heal, and it automatically follows that it is necessary to follow the instructions of a competent doctor. Yet at the same time, one must clearly know that God is the Healer of all flesh and the Worker of wonders, and `a particular man and a particular drug' are merely His agents and means. It follows that first and foremost one must work to improve and strengthen one's spiritual health, because this strengthens one's attachment to God, and then `you are all alive this day' (Deuteronomy 4:4) with actual physical vitality and in all one's limbs" (ibid. p.23).

Even when receiving medical treatment, one must follow the spiritual pathway of healing not as a mere "extra" but as the very foundation of true healing. Many people put all the emphasis on medical treatment not so much because they are committed to using every possible physical strategy to bring about a cure - if they truly had such a commitment, they would reform their diets, take up exercise and make all the other changes in their lifestyle that would be conducive to better health. Rather their reason is because passive submission to treatment involves much less effort than active steps to change one's life.

This may explain some of the antagonism people have to the idea that physical illness is often rooted in a spiritual flaw. The implication is that true healing can only come about when the patient has the courage to examine himself honestly and take responsibility for his life. For many people this is simply too uncomfortable. It is easier to believe that illness "just happens" to people, and to run to the doctor and say "Cure me! You do the work!"

Likewise, to depend on God for healing does not mean passively waiting for miracles. We have to do our part, not only by going to the doctor and receiving the necessary treatment, but by actively turning to God in every phase of illness and recovery. At times we may have to literally cry and scream out to God for help, or make heroic efforts to recite our prayers and carry out basic mitzvot despite severe pain and disability. Turning to God may involve giving charity or asking a Tzaddik to make a pidyon. At other times, turning to God means meditating, thinking and pondering carefully, asking what this illness means and what it comes to teach. What is our purpose in this world? How have we been leading our lives? What practical steps do we need to take to bring our lives to a higher level? And how can we take the immediate next step?

A word to doctors

Some doctors may be amused by Rebbe Nachman's scathing attacks on doctors, and in fact may even agree. Others, however, may be deeply upset when they hear that in spite of their years of training, hard-earned expertise and dedication to relieving people's misery, they are nothing but "emissaries of the Angel of Death."

Without doubt the great majority of doctors are sincere and well-intentioned. However, every doctor should be sobered by the disturbing present-day trend for doctors to become not only the preservers of life but takers of life as well. Not only has abortion become virtually a standard medical routine despite the fact that Torah law prohibits the killing of an unborn fetus when the mother's life is not at stake. Even more horrifying is the increasingly widespread acceptance of active medical euthanasia, which in Torah law is considered plain murder. Rebbe Nachman's accusation that doctors are "literally murderers, killing people with their own hands" certainly applies to any doctor involved in abortion or euthanasia in contravention of Torah law.

An honest healer will take his responsibility with the utmost seriousness and keep at the forefront of his mind the words of the Me'iri explaining why "the best of physicians are destined to go to hell" - because 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 if he is expert and causes the death of the patient" (Me'iri on Kiddushin 82a, see p. 194). The Maharsha (Rabbi Shmuel Eliezer Aideles) says (ad loc.): "The best of doctors means a doctor who considers himself the best. He relies only on his own wisdom, and there are times when his haughtiness and conceit cause him to diagnose an illness incorrectly, and as a result, his patient dies. He should make it a habit always to consult another physician, because a life has been placed in his hands."

The awesomeness of the doctor's responsibility should not, however, deter him from practicing his craft. On the contrary, healing "is a mitzvah, and it is included in the category of saving life; and if the doctor withholds his services, it is considered as shedding blood" (Shulchan Arukh, Yoreh Deah 336:1). As we have seen, even for the Ramban, who asked what place doctors have in the house of those who carry out the will of God, the issue is not whether doctors have sanction to heal but rather, whether the sick have license to turn to the doctor. However, "if a patient has already come to the doctor, the doctor should not refrain from treating him" (Ramban on Leviticus 26:11).

Despite the severity of Rebbe Nachman's language against doctors, his main thrust is not so much against the doctors themselves as against those who put all their faith and trust in them and look to medicines to cure them instead of lifting their eyes and hearts to God. The doctor is in a unique position to help his patients put the medical aspects of their healing in the correct perspective and to influence them to deepen their faith in God. Thus the Lubavitcher Rebbe wrote to a doctor:

"When patients consult you about their physical problems, I trust that, like many God-fearing doctors, you too take the opportunity to inspire and encourage them to work to heal their souls as well, which everyone in this orphaned generation needs, since `no one on earth is so righteous that he does only good and does not sin' (Ecclesiastes 7:20). Moreover, we see clearly that an improvement in a person's spiritual health also brings an improvement in his or her physical health - quite literally..." (Refuah Shelemah p. 21).

Writing to another doctor, the Lubavitcher Rebbe recommends that he should

"...decisively negate the theory of the dominion of the material, by paying attention to the extent to which the health of the body is dependent upon the health of the soul. If the traditional medical maxim emphasized `a healthy mind in a healthy body,' in our days it has become manifestly clear how a small blemish in the soul leads to major damage in the body, and the healthier the soul, the greater its power over the body and its ability to rectify deficiencies in the body, to the point that many physical treatments are far more effective in healing the body when combined with the willpower and other spiritual powers of the patient" (ibid. p.21).

"It's not the doctor who heals, but the angel who goes with him"

Let us leave the final word on the subject of doctors to Dr. Guardia - Rabbi Aharon ben Shimon Rofey - to whom Rebbe Nachman himself was willing to take his wife. Once a poverty-stricken woman came running to Dr. Guardia. She pounded on his door, crying "Doctor! Help! Have pity! You must save my husband! He's the father of eight children! We're totally impoverished! He struggles to give us a living, and now he's stretched out on his bed like a stone. Have pity on our children! Do what you can, Doctor!" After hearing the woman out, Dr. Guardia casually went back into his house.

"It's urgent!" cried the woman, "It's a matter of moments! Help!" "Yes," replied Dr. Guardia, patiently brushing his coat, "I'm on my way." He picked up his hat and started brushing it. More and more distraught, the woman cried out: "Is your heart made of stone? You have the power to save his life - how can you carry on like this?" Unperturbed, Dr. Guardia carried on brushing his hat. Finally, in disgust, the woman cried, "Enough! It's impossible to trust this doctor. Only You, Master of the World, You alone can help!" As she turned to leave, Doctor Guardia leapt out of the house and went running on ahead to her house. By the time she arrived, the doctor was already giving her husband medicine, and in due course he recovered.

Afterwards the man's wife asked Doctor Guardia why he had taken so long to leave his house. "Don't you understand?" he replied. "It's not the doctor who heals, but the angel who goes with him. When you unthinkingly said that only the doctor can help, I knew very well that no angel would be willing to come with me, because the angels do not attach themselves to those who forget their Creator. I therefore had to do everything I could to get you to understand that only God can help. When you finally ran out trusting only in God, I was able to come to your house and attend to your husband" (The Magid of Mezritch, by R.Y. Klapholtz).

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